The impact of the European Working Time Regulations on Ophthalmic Specialist Training--a national trainee survey.

SUMMARY AND INTRODUCTION: To assess ophthalmic trainees' perspective of the impact of the European Working Time Regulations (EWTR) on their training. METHODS: All trainees in ophthalmology in the UK were emailed a link to an electronic survey asking about their experiences of the EWTR. RESULTS: 324 trainees (46% of those invited) responded to the survey. 44.4% of trainees reported that their posts were compliant with the EWTR. 40.7% felt that training had been adversely affected. 49.1% thought that ophthalmic trainees should opt out of the EWTR to work more than 48 h per week, with 57 the mean number of hours suggested appropriate. DISCUSSION: Many ophthalmic trainees in the United Kingdom are working in rotas which are not compliant with the European Working Time Directive. Many trainees feel that implementation of the EWTD has had a negative effect on training and feel it would be acceptable to work a higher number of hours per week.

Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 4: 'can the patient see?' Timely diagnosis, dilemmas and pitfalls in the multiply injured, poorly responsive/unresponsive patient.

Assessment of the eyes and visual pathways in the multiply injured patient with co-existing craniofacial injuries can be very difficult. Although ocular injury is common in facial trauma, vision-threatening injuries and severe visual impairment are less frequently seen and may be associated with specific injury patterns. Some vision-threatening injuries require early diagnosis and treatment if useful sight is to be preserved, but at the same time this must not interfere with any ongoing investigations and resuscitation. Progressive swelling, blood loss and some therapeutic interventions may all potentially contribute to loss of vision later on, highlighting the need for repeated assessment. In many cases initial assessment is limited, especially in the confused, agitated or unresponsive patient, but early recognition of significant ocular injuries is important for a number of reasons. Arguably, initial assessment should be to confidently exclude a sight-threatening injury, requiring emergent or urgent intervention. More detailed ophthalmic examination can be performed later, when the patient is in a better condition. The management of the severely proptosed eye in the multiply injured unconscious patient is also a very difficult area, particularly if the precise cause is unknown. A number of causes exist and these may require different therapeutic strategies, which are discussed.

Relationships between clinical measures of visual function, fluorescein angiographic and optical coherence tomography features in patients with subfoveal choroidal neovascularisation.

AIMS: To examine the relationships between measures of vision, optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) characteristics in patients with exudative age-related macular degeneration (AMD). STUDY DESIGN: Retrospective case note review. Inclusion criteria were: confirmed diagnosis of new exudative AMD; recorded visual function using best corrected distance visual acuity (DVA), near visual acuity (NVA) and contrast sensitivity; corresponding FFA and OCT. FFA parameters included greatest linear diameter of lesion (GLD), area of choroidal neovascularisation (CNV) and area of leakage. OCT parameters included maximum retinal thickness (Ret(max)), central foveal thickness, maximum thickness of the CNV (CNV(max)), and the distances from the foveal depression to Ret(max) and CNV(max). RESULTS: 74 patients were included in this study. Correlations were highly statistically significant for both NVA and contrast sensitivity with GLD, CNV area and leakage (p<0.01 for all combinations). With DVA, modest statistically significant correlations were seen with CNV area and GLD (p<0.05). There was a statistically significant correlation between CNV leakage and the distance of CNV(max) to the fovea (p<0.05). The relationships between the measures of vision and OCT parameters were weak and did not reach significance. Regression analysis showed that the combination of Ret(max), GLD, and CNV(max) to fovea had the highest coefficient (r2 = 0.27). CONCLUSION: OCT measurements by themselves are not robust markers for visual function.