Síndrome de desgaste profesional o «burnout» en la oftalmología andaluza / Syndrome of professional wear and tear or «burnout» in Andalusian ophthalmology

INTRODUCCIÓN: El síndrome de desgaste profesional, más conocido por su traducción inglesa de síndrome de burnout, hace referencia al cansancio físico y psicológico que sufre un trabajador como consecuencia de su actividad laboral. Se caracteriza por cansancio emocional, despersonalización y falta de realización personal. OBJETIVO: Determinar la prevalencia del síndrome de burnout entre los oftalmólogos andaluces, tanto adjuntos como residentes, analizando su relación con diversas variables sociodemográficas. MATERIAL Y MÉTODOS: Estudio descriptivo con carácter transversal. Se incluyeron dentro de un formulario de Google(R) todas las variables sociodemográficas a estudiar junto al cuestionario estandarizado Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Este formulario se remitió a la comunidad oftalmológica andaluza por diferentes medios electrónicos (Sociedad Andaluza de Oftalmología, aplicaciones móviles de mensajería instantánea, etc.). RESULTADOS: Ciento cuarenta y dos oftalmólogos contestaron el cuestionario, con una distribución similar por sexos, y una edad media de 43,77 años, cumpliendo criterios de burnout ocupacional el 67,61% de ellos. Su prevalencia fue mayor entre los oftalmólogos jóvenes con menos años de práctica clínica, divorciados/separados, aquellos con menor número de hijos, pertenecientes a centros de la provincia de Huelva, trabajadores de ámbitos rurales/comarcales, aquellos con actividad pública exclusiva, adjuntos con contratos eventuales y residentes de 4.° año. En cuanto a subespecialidades, la prevalencia resultó mayor entre los que se dedican a córnea-superficie ocular-cirugía refractiva. CONCLUSIONES: Este trabajo objetiva por primera vez en Andalucía el desgaste profesional de los oftalmólogos. El hecho de que dos terceras partes de la muestra estudiada cumplan criterios de síndrome de burnout evidencia la necesidad de implementar mejoras en las condiciones asistenciales y profesionales de nuestro colectivo

INTRODUCTION: Burnout syndrome refers to the physical and psychological fatigue suffered by workers as a result of their professional activity. It has three main characteristics: emotional exhaustion, depersonalization and lack of personal fulfillment. PURPOSE: To determine the prevalence of burnout syndrome among Andalusian ophthalmologists, both consultants and residents, analyzing its relationship with several sociodemographic variables. MATERIAL AND METHODS: Descriptive cross-sectional study. All the sociodemographic variables were included in a Google(R) form together with the standardized questionnaire Maslach Burnout Inventory-Human Services Survey (MBI-HSS). This form was sent to the Andalusian ophthalmological community by different electronic means (Andalusian Society of Ophthalmology, instant messaging mobile apps, etc.). RESULTS: One hundred fourty two ophthalmologists answered the form, with a similar distribution by sex and a mean age of 43.77 years, with 67.1% of them meeting criteria of burnout syndrome. Its prevalence was higher among young ophthalmologists, with fewer years of clinical practice, divorced/separated, those with fewer children, belonging to centers in the province of Huelva, workers in rural/regional areas, those with exclusive public activity, consultants with temporary contracts and four-year residents. Regarding subspecialties, its prevalence was higher among those who focused on cornea-ocular surface-refractive surgery. CONCLUSIONS: This study quantify for the first time in Andalusia the prevalence of burnout syndrome among ophthalmologists. The fact that two thirds of the analyzed sample meet criteria proves the need to implement improvements in the clinical and professional conditions of our group

Syndrome of professional wear and tear or «burnout¼ in Andalusian ophthalmology. / Síndrome de desgaste profesional o «burnout¼ en la oftalmología andaluza.

INTRODUCTION: Burnout syndrome refers to the physical and psychological fatigue suffered by workers as a result of their professional activity. It has three main characteristics: emotional exhaustion, depersonalization and lack of personal fulfillment. PURPOSE: To determine the prevalence of burnout syndrome among Andalusian ophthalmologists, both consultants and residents, analyzing its relationship with several sociodemographic variables. MATERIAL AND METHODS: Descriptive cross-sectional study. All the sociodemographic variables were included in a Google® form together with the standardized questionnaire Maslach Burnout Inventory-Human Services Survey (MBI-HSS). This form was sent to the Andalusian ophthalmological community by different electronic means (Andalusian Society of Ophthalmology, instant messaging mobile apps, etc.). RESULTS: One hundred fourty two ophthalmologists answered the form, with a similar distribution by sex and a mean age of 43.77 years, with 67.1% of them meeting criteria of burnout syndrome. Its prevalence was higher among young ophthalmologists, with fewer years of clinical practice, divorced/separated, those with fewer children, belonging to centers in the province of Huelva, workers in rural/regional areas, those with exclusive public activity, consultants with temporary contracts and four-year residents. Regarding subspecialties, its prevalence was higher among those who focused on cornea-ocular surface-refractive surgery. CONCLUSIONS: This study quantify for the first time in Andalusia the prevalence of burnout syndrome among ophthalmologists. The fact that two thirds of the analyzed sample meet criteria proves the need to implement improvements in the clinical and professional conditions of our group.

Importancia de la electrofisiología ocular en el diagnóstico de las distrofias retinianas / Importance of ocular electrophysiology in the diagnosis of retinal dystrophies

Antecedentes y objetivo: El diagnóstico de las distrofias retinianas es complejo y se basa en estudio oftalmológico completo, estudio genético y los estudios electrofisiológicos (EEF). En este estudio pretendemos evaluar el papel de las pruebas electrofisiológicas y del médico solicitante en el diagnóstico de las distrofias de retina. Materiales y métodos: Estudio observacional retrospectivo. Se seleccionaron 50 pacientes atendidos en el Servicio de Neurofisiología del Hospital Universitario Virgen Macarena. Se valoró el sexo, la edad, el hospital de origen, motivo por el que se solicitó los EEF, diagnóstico de presunción tras examen oftalmológico, EEF realizados, estudio genético y el diagnóstico definitivo tras realización de EEF. Se elaboró un sistema de clasificación que otorga a cada caso un valor comprendido entre 0 y 2, en función de la contribución de las pruebas electrofisiológicas al diagnóstico final. Resultados: La edad media fue 44,34 ± 18,03 años (60% mujeres). Retinosis pigmentaria, neuropatía óptica y enfermedad de Stargardt fueron los diagnósticos más frecuentes. Los EEF modificaron el diagnóstico de presunción en el 48% de los casos, confirmaron el diagnóstico en el 44% y no aportaron información en el 8%. La contribución de los EEF fue mayor en pacientes atendidos en el Hospital Universitario Virgen Macarena y cuando se solicitaban por hallazgos en la exploración (p = 0,001). Los falsos positivos para distrofia retiniana fueron del 60% en pacientes no valorados en dicho hospital. Conclusiones: Las pruebas electrofisiológicas y el manejo especializado de los pacientes con distrofias retinianas desempeñan un papel importante en el diagnóstico de estas patologías

Background and objective; The diagnosis of retinal dystrophies is complex and is based on complete ophthalmological study, genetic study and electrophysiological studies (EPS). In this study, we intend to evaluate the role of electrophysiological and medical tests in the diagnosis of retinal dystrophies. Material and methods: A retrospective observational study was conducted on 50 selected patients that attended the Neurophysiology Department of the University Hospital Virgen Macarena. An analysis was made of the variables that included, gender, age, referral hospital, reason for which the EPS was requested, applied EPS, genetic study, presumed diagnosis, and definitive diagnosis after EPS. A classification system was subsequently developed, which gives each case a value between 0 and 2, depending on the contribution of the electrophysiological tests to the final diagnosis. Results: The mean age was 44.34 ± 18.03 years (60% women). Retinitis pigmentosa (24%), optic neuropathy (12%), and Stargardt's disease (8%) were the most frequent diagnoses. The EPS modified the presumed diagnosis in 48% of the cases, confirmed the diagnosis in 44%, and did not provide any useful information in 8%. The contribution of the EPS was greater in patients seen in the HUVM and when requested by findings in the examination (P = .001). The false positives in the diagnosis of retinal dystrophy were 60% in patients not evaluated by the University Hospital Virgen Macarena. Conclusions: Electrophysiological test and specialised management of patients with retinal dystrophies play an important role in the diagnosis of these conditions

Importance of ocular electrophysiology in the diagnosis of retinal dystrophies. / Importancia de la electrofisiología ocular en el diagnóstico de las distrofias retinianas.

BACKGROUND AND OBJECTIVE: The diagnosis of retinal dystrophies is complex and is based on complete ophthalmological study, genetic study and electrophysiological studies (EPS). In this study, we intend to evaluate the role of electrophysiological and medical tests in the diagnosis of retinal dystrophies. MATERIAL AND METHODS: A retrospective observational study was conducted on 50 selected patients that attended the Neurophysiology Department of the University Hospital Virgen Macarena. An analysis was made of the variables that included, gender, age, referral hospital, reason for which the EPS was requested, applied EPS, genetic study, presumed diagnosis, and definitive diagnosis after EPS. A classification system was subsequently developed, which gives each case a value between 0 and 2, depending on the contribution of the electrophysiological tests to the final diagnosis. RESULTS: The mean age was 44.34 ±18.03 years (60% women). Retinitis pigmentosa (24%), optic neuropathy (12%), and Stargardt's disease (8%) were the most frequent diagnoses. The EPS modified the presumed diagnosis in 48% of the cases, confirmed the diagnosis in 44%, and did not provide any useful information in 8%. The contribution of the EPS was greater in patients seen in the HUVM and when requested by findings in the examination (P=.001). The false positives in the diagnosis of retinal dystrophy were 60% in patients not evaluated by the University Hospital Virgen Macarena. CONCLUSIONS: Electrophysiological test and specialised management of patients with retinal dystrophies play an important role in the diagnosis of these conditions.

[Guidelines of clinical practice of the SERV (Spanish Retina and Vitreous Society): management of ocular complications of diabetes. Diabetic retinopathy and macular oedema]. / Guías de práctica clínica de la SERV: manejo de las complicaciones oculares de la diabetes. Retinopatía diabética y edema macular.

OBJECTIVE: Diabetes mellitus is considered the most common cause of blindness in the working population of industrialized countries, with diabetic macular edema being the most common cause of decreased visual acuity and proliferative diabetic retinopathy (PDR) being responsible for the most severe visual deficits. We have therefore tried to establish a guide for clinical intervention whose purpose is to provide orientation on the treatment of diabetic retinopathy and its complications. This is necessary at a time when many treatment options have emerged whose role is not yet fully defined. METHOD: A group of expert retina specialists selected by the SERV (Vitreous-Retina Spanish Society) assessed the published results of different treatment options currently available, suggesting lines of action according to the degree of diabetic retinopathy present and the presence or absence of macular edema. RESULTS: PDR is primarily treated with pan-retinal photocoagulation. For clinically significant diabetic macular edema without signs of vitreomacular traction, the treatment of choice continues to be focal/grid photocoagulation. Similarly, retinovitreal surgery is indicated for both conditions. The use of antiangiogenic drugs was also analyzed but remains inconclusive. CONCLUSION: Laser therapy is effective in the management of diabetic retinopathy and diabetic macular edema. The role of antiangiogenics is not yet sufficiently defined.

Guías de Práctica Clínica de la SERV: Manejo de las complicaciones oculares de la diabetes. Retinopatía diabética y edema macular / Guidelines of Clinical Practice of the SERV: Management of ocular complications of diabetes. Diabetic retinopathy and macular oedema

Objetivo: La diabetes mellitus está considerada como la causa más frecuente de ceguera en lapoblación activa en los países industrializados,siendo el edema macular diabético la causa más frecuentede disminución de la agudeza visual y laretinopatía diabética proliferante la responsable delos déficit visuales más severos. Por ello hemosintentado establecer una guía de actuación clínicacuyo propósito es proporcionar unas directrices quesirvan de orientación para el tratamiento de la retinopatía diabética y sus complicaciones. Esto sehace necesario en un momento en el que han aparecidonumerosas alternativas terapéuticas cuyo papelaún no está completamente definido.Método: Un grupo de expertos retinólogos seleccionadospor la SERV han evaluado los resultadospublicados sobre las distintas opciones terapéuticasque existen en la actualidad, en base a lo cual sesugieren líneas de actuación según el grado de retinopatíadiabética que presenta el paciente y la presenciao no de edema macular.Resultados: El tratamiento princeps de la RDP esla panretinofotocoagulación (PFC). El tratamientode elección en el edema macular diabético clínicamentesignificativo sin signos de tracción vítreomacular continúa siendo la fotocoagulaciónfocal/rejilla. La cirugía retinovítrea tiene así mismosus indicaciones en ambas afecciones. Se discute eluso de fármacos antiangiogénicos.Conclusión: La laserterapia es efectiva en el manejode la RD y del EMD. El papel de los antiangiogénicosaún no está suficientemente definido (AU)

Objective: Diabetes mellitus is considered the most common cause of blindness in the working populationof industrialized countries, with diabetic macularedema being the most common cause of decreasedvisual acuity and proliferative diabetic retinopathy(PDR) being responsible for the most severevisual deficits. We have therefore tried to establisha guide for clinical intervention whose purpose is toprovide orientation on the treatment of diabetic retinopathyand its complications. This is necessary at a time when many treatment options have emergedwhose role is not yet fully defined.Method: A group of expert retina specialists selectedby the SERV (Vitreous-Retina Spanish Society)assessed the published results of different treatmentoptions currently available, suggesting lines ofaction according to the degree of diabetic retinopathypresent and the presence or absence of macularedema.Results: PDR is primarily treated with pan-retinalphotocoagulation. For clinically significant diabeticmacular edema without signs of vitreomacular traction,the treatment of choice continues to befocal/grid photocoagulation. Similarly, retinovitrealsurgery is indicated for both conditions. The use ofantiangiogenic drugs was also analyzed but remainsinconclusive.Conclusion: Laser therapy is effective in the managementof diabetic retinopathy and diabetic macularedema. The role of antiangiogenics is not yet sufficiently defined (AU)

[Herpes simplex keratitis following laser in situ keratomileusis]. / Queratitis por herpes simplex tras láser in situ keratomileusis.

CASE REPORT: A 40-year-old woman underwent bilateral Laser In Situ Keratomileusis (LASIK) for the correction of myopia and astigmatism. The day after, four dendritic ulcers appeared in her left eye. She was treated with topical antiviral agents until complete recovery. She had a history of recurrent labial herpetic infection. DISCUSSION: Reactivation of herpes simplex virus type 1 can occur, even without any previous history of corneal infection. Although this does not contraindicate surgery, all patients with a history of herpetic infection should be made aware of the complications related to this technique.

Metástasis en iris: hallazgo casual / Metastasis in iris: a casual discovery

Caso clínico: Presentamos un caso de probable metástasis en iris, como hallazgo casual, en una paciente diagnosticada de carcinoma de mama.Discusión: Las metástasis carcinomatosas van a constituir la primera causa de tumor maligno intraocular; siendo los carcinomas de pulmón y mama los que lo hacen con mayor frecuencia. Las metástasis en iris son las menos frecuentes dentro del tracto uveal. Debe realizarse diagnóstico diferencial minucioso, sobretodo si se trata de la primera manifestación de la enfermedad. En estos casos la punción-biopsia de la lesión se muestra como un método diagnóstico efectivo. (AU)

[Metastasis to the iris: a casual finding]. / Metástasis en iris: hallazgo casual.

CASE REPORT: We present a case of potential iris metastasis, as casual a finding, in a patient diagnosed from breast carcinoma. DISCUSSION: Cancer metastases constitute the first cause of intraocular malignant disease, being the lung and breast carcinomas the most frequent primary tumors. Iris metastasis is the least frequent among malignant involvement of the uveal tract. A meticulous differential diagnosis is advisable, mainly if metastasis is the first manifestation of the disease. In these particular situations puncture-biopsy of the lesion seems an effective diagnostic method.