Sir Harold Ridley as the Pioneer of Intraocular Lenses: His Inspiration Drawn From World War II Pilots.

This article underscores the monumental contributions of Sir Harold Ridley to the development of intraocular lenses (IOLs), which have revolutionized cataract surgery. Sir Harold Ridley, a British ophthalmologist and medical scientist, drew inspiration from the injuries of World War II pilots to pioneer the first successful IOL implantation in 1949 at St. Thomas's Hospital. The lens, made from Perspex CQ, marked the inception of modern cataract surgery. Despite facing considerable skepticism and resistance from the medical community throughout the 1950s and 60s, Ridley's perseverance led to the gradual acceptance of IOLs by the 1970s. Today, Ridley is rightfully recognized as the "father of the intraocular lens," with his groundbreaking work having profoundly impacted the field of ophthalmology and improved the quality of life for millions globally.

A review of ophthalmology education in the era of generative artificial intelligence.

PURPOSE: To explore the integration of generative AI, specifically large language models (LLMs), in ophthalmology education and practice, addressing their applications, benefits, challenges, and future directions. DESIGN: A literature review and analysis of current AI applications and educational programs in ophthalmology. METHODS: Analysis of published studies, reviews, articles, websites, and institutional reports on AI use in ophthalmology. Examination of educational programs incorporating AI, including curriculum frameworks, training methodologies, and evaluations of AI performance on medical examinations and clinical case studies. RESULTS: Generative AI, particularly LLMs, shows potential to improve diagnostic accuracy and patient care in ophthalmology. Applications include aiding in patient, physician, and medical students' education. However, challenges such as AI hallucinations, biases, lack of interpretability, and outdated training data limit clinical deployment. Studies revealed varying levels of accuracy of LLMs on ophthalmology board exam questions, underscoring the need for more reliable AI integration. Several educational programs nationwide provide AI and data science training relevant to clinical medicine and ophthalmology. CONCLUSIONS: Generative AI and LLMs offer promising advancements in ophthalmology education and practice. Addressing challenges through comprehensive curricula that include fundamental AI principles, ethical guidelines, and updated, unbiased training data is crucial. Future directions include developing clinically relevant evaluation metrics, implementing hybrid models with human oversight, leveraging image-rich data, and benchmarking AI performance against ophthalmologists. Robust policies on data privacy, security, and transparency are essential for fostering a safe and ethical environment for AI applications in ophthalmology.

Flipped Classroom Based on Outcomes-Based Education Improves Student Engagement and Clinical Analysis Competence in Undergraduates Ophthalmology Clerkship.

Objective: To investigate the effectiveness of flipped classrooms (FC) based on outcomes-based education (OBE) on clinical ophthalmology clerkships. Methods: Ninety-nine undergraduates were non-randomly assigned to the FC based on the OBE (FC-OBE) group or traditional lecture (TL) group in the ophthalmology clerkship. Pre- and post-tests were performed to assess student learning outcomes. Anonymous questionnaires were collected to compare students' attitudes and classroom engagements between the two groups. Results: More participants agreed FC-OBE was helpful in developing teamwork ability and knowing the work standard. Teaching staff in the FC-OBE classroom received higher evaluations. More participants in the FC-OBE group had higher classroom engagement in skills and emotions than in the TL group. The post-class test scores, mainly case analysis scores were higher in the FC-OBE group than in the TL group. Conclusion: FC-OBE classroom improves student engagement and clinical analysis competence in undergraduate ophthalmology clerkship.

Experience of focused workshop intervention in presentation skills - Importance of foundational skills for ophthalmologists in training.

Background: The study was conducted to assess the impact of a workshop intervention designed to enhance presentation skills of ophthalmology fellows in training. Methods: A 10-hour workshop on presentation skills was conducted for ophthalmology fellows in the 2022 cohort at a single institution. An email was sent to the 2022 cohort to recruit participants. A total of 29 fellows (19 females, 10 males) volunteered to participate in the study. Participants completed a self-rating questionnaire to assess improvement in their presentation skills at four different time points of the workshop. The self-rating questionnaire utilized a ten-point rating scale (1-10) and evaluated properties and content (PC) and soft skills (SS). Data were analysed using SPSS software. Friedman and post-hoc tests compared self-ratings at four time points. Statistical significance was set at p-value < 0.05. Results: Both properties & content (PC) and soft skills (SS) showed significant difference (p < 0.001) post workshop compared to earlier stages. The higher self-rating (PC4 and SS4) highlights increased awareness towards the scope of improving the presentation after the workshop intervention. Conclusions: Presentation skills empower medical professionals to better communicate with diverse audiences, demonstrating their currency in medical knowledge, lobbying for correct understanding, and bringing praxis to pedagogy. The findings support the integration of similar workshops into medical curricula to foster well-rounded medical professionals.

The Decline of Basic Ophthalmology in General Medical Education: A Scoping Review and Recommended Potential Solutions.

OBJECTIVE: This literature review aims to explore research and conceptual pieces on the state of ophthalmology education and suggest potential ways to address current challenges. METHODS: A search was conducted in PubMed, ERIC, Web of Science, and Google Scholar with combinations of the following search terms: "ophthalmology education," "undergraduate medical education," "medical student," "United States," and "Canada." Eliminating irrelevant articles yielded 47 articles. Three were excluded because of region and focus, leaving 44. After examining the citations, we generated an additional 22 texts for review, totaling 66 articles. RESULTS: Four primary themes were identified: (1) challenges to ophthalmological education in the U.S. and Canada, (2) potential remedies for optimizing ophthalmology curriculum, (3) technology in ophthalmology education, and (4) innovative ophthalmology teaching approaches. Major challenges included the lack of a standardized curriculum and inadequate clinical exposure and skills training. A number of remedies were proposed, such as standardizing curriculum and furthering faculty involvement, utilizing technology as time-effective learning aids, and employing innovative teaching approaches such as service learning. CONCLUSION: In light of challenges in ophthalmology education, curriculum designers should consider Cognitive Load Theory (CLT) to assist students to remember meaningful exposures to ophthalmology knowledge and techniques. Based on CLT, we suggest two potential approaches to incorporating ophthalmology curriculum. The first is to embrace interdisciplinary collaborations and place ophthalmology knowledge in varied contexts to facilitate schema construction. The second is to incorporate ophthalmology diagnostics requirements into OSCEs and utilize simulation models for students to gradually increase the fidelity of tasks and devote cognitive resources fully to learning.

Assessing the Utility of ChatGPT in Simplifying Text Complexity of Patient Educational Materials.

INTRODUCTION: AI chatbots are being increasingly used in healthcare settings. There is growing interest in using AI to assist in patient education. Currently, extensive healthcare information is found online but is often too complex to understand. Our objective is to determine if physicians can recommend the free version of ChatGPT version 3.5 (OpenAI, San Francisco, CA, USA) for patients to simplify text from the American Academy of Ophthalmology (AAO) in English and Spanish. This version of ChatGPT was assessed in this study due to its increased accessibility across various patient populations. METHODS: Fifteen articles were chosen from AAO in both languages and simplified with ChatGPT 10 times each. The readability of original and simplified articles was assessed with the Flesch Reading Ease and Gunning Fog Index for English and Fernández Huerta, Gutiérrez, Szigriszt-Pazo, INFLESZ, and Legibilidad-µ for Spanish. Grade levels to assess readability were calculated with Flesch Kincaid Grade Level and Crawford Nivel-de-Grado. Mean, standard deviation, and two-tailed t-tests were performed to assess differences before and after simplification. RESULTS: Average grade levels before and after simplification were as follows: English 8.43±1.17 to 8.9±2.1 (p=0.41) and Spanish 5.3±0.34 to 4.1±1.1 (p=0.0001). Spanish articles were significantly simplified per Legibilidad-µ (p=0.003). No significant difference was noted for other scales. CONCLUSIONS: The readability of AAO articles in English worsened without significance but significantly improved in Spanish. This may result from simpler syllable structures and a lesser overall vocabulary in Spanish. With increased testing, physicians can recommend ChatGPT for Spanish-speaking patients to improve health literacy.

A Systematic Review of Ophthalmology Education in Medical Schools: The Global Decline.

TOPIC: This systematic review examined geographical and temporal trends in medical school ophthalmology education in relationship to course and student outcomes. CLINICAL RELEVANCE: Evidence suggesting a decline in ophthalmology teaching in medical schools is increasing, raising concern for the adequacy of eye knowledge across the rest of the medical profession. METHODS: Systematic review of Embase and SCOPUS, with inclusion of studies containing data on medical school ophthalmic course length; 1 or more outcome measures on student ophthalmology knowledge, skills, self-evaluation of knowledge or skills, or student course appraisal; or both. The systematic review was registered prospectively on the International Prospective Register of Systematic Reviews (identifier, CRD42022323865). Results were aggregated with outcome subgroup analysis and description in relationship to geographical and temporal trends. Descriptive statistics, including nonparametric correlations, were used to analyze data and trends. RESULTS: Systematic review yielded 4596 publication titles, of which 52 were included in the analysis, with data from 19 countries. Average course length ranged from 12.5 to 208.7 hours, with significant continental disparity among mean course lengths. Africa reported the longest average course length at 103.3 hours, and North America reported the shortest at 36.4 hours. On average, course lengths have been declining over the last 2 decades, from an average overall course length of 92.9 hours in the 2000s to 52.9 hours in the 2020s. Mean student self-evaluation of skills was 51.3%, and mean student self-evaluation of knowledge was 55.4%. Objective mean assessment mark of skills was 57.5% and that of knowledge was 71.7%, compared with an average pass mark of 66.7%. On average, 26.4% of students felt confident in their ophthalmology knowledge and 34.5% felt confident in their skills. DISCUSSION: Most evidence describes declining length of courses devoted to ophthalmology in the last 20 years, significant student dissatisfaction with courses and content, and suboptimal knowledge and confidence. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Leveraging ChatGPT for ophthalmic education: A critical appraisal.

In recent years, the advent of artificial intelligence (AI) has transformed many sectors, including medical education. This editorial critically appraises the integration of ChatGPT, a state-of-the-art AI language model, into ophthalmic education, focusing on its potential, limitations, and ethical considerations. The application of ChatGPT in teaching and training ophthalmologists presents an innovative method to offer real-time, customized learning experiences. Through a systematic analysis of both experimental and clinical data, this editorial examines how ChatGPT enhances engagement, understanding, and retention of complex ophthalmological concepts. The study also evaluates the efficacy of ChatGPT in simulating patient interactions and clinical scenarios, which can foster improved diagnostic and interpersonal skills. Despite the promising advantages, concerns regarding reliability, lack of personal touch, and potential biases in the AI-generated content are scrutinized. Ethical considerations concerning data privacy and potential misuse are also explored. The findings underline the need for carefully designed integration, continuous evaluation, and adherence to ethical guidelines to maximize benefits while mitigating risks. By shedding light on these multifaceted aspects, this paper contributes to the ongoing discourse on the incorporation of AI in medical education, offering valuable insights and guidance for educators, practitioners, and policymakers aiming to leverage modern technology for enhancing ophthalmic education.

Effect of the COVID-19 pandemic on cataract surgery by residents who had routine surgical simulator training during residency

ABSTRACT Purpose: To assess the effect of the coronavirus disease 2019 (COVID-19) pandemic on cataract surgery by residents who had mandatory surgical simulator training during residency. Methods: In this retrospective, observational analytical study, the total number of cataract surgeries and surgical complications by all senior residents of 2019 (2019 class; prepandemic) and 2020 (2020 class; affected by the reduced number of elective surgeries due to the COVID-19 pandemic) were collected and compared. All residents had routine mandatory cataract surgery training on a virtual surgical simulator during residency. The total score obtained by these residents on cataract challenges of the surgical simulator was also evaluated. Results: The 2020 and 2019 classes performed 1275 and 2561 cataract surgeries, respectively. This revealed a reduction of 50.2% in the total number of procedures performed by the 2020 class because of the pandemic. The incidence of surgical complications was not statistically different between the two groups (4.2% in the 2019 class and 4.9% in the 2020 class; p=0.314). Both groups also did not differ in their mean scores on the simulator's cataract challenges (p<0.696). Conclusion: Despite the reduction of 50.2% in the total number of cataract surgeries performed by senior residents of 2020 during the COVID-19 pandemic, the incidence of surgical complications did not increase. This suggests that surgical simulator training during residency mitigated the negative effects of the reduced surgical volume during the pandemic.

Nurse Practitioner Students' Knowledge Assessment and Perceived Preparedness to Triage Ophthalmology Complaints in a Primary Care Setting: An Educational Intervention.

Purpose In this proof-of-concept pilot study, we aimed to increase nurse practitioner (NP) student knowledge of ophthalmology to prepare NPs for encounters in primary care settings. The Association of University Professors of Ophthalmology (AUPO) and the American Academy of Ophthalmology (AAO) endorse core knowledge that medical students should achieve. We assess the effectiveness of an innovative ophthalmologist-led curriculum based on these competencies tailored to issues NPs encounter in primary care. Methods Johns Hopkins University NP students enrolled in a pre-post-cohort study and educational intervention. The didactic program was developed according to AUPO and AAO core ophthalmology content for medical students and was taught in-person by an ophthalmologist. Pre-post-assessments evaluated students' perceived readiness to encounter ophthalmic issues in the clinic and baseline knowledge of core competencies of ophthalmology. Results A total of 42 NP students were included in the analysis. NP students improved in core knowledge and readiness to encounter ophthalmology issues. After the educational event, there was a statistically significant improvement in students' ratings of preparedness to obtain a focused history, exam, perform initial management and decide the urgency of a referral for acute painless vision loss ( p < 0.001), chronic vision loss ( p < 0.001), or a patient with a red/painful eye ( p < 0.001). Students showed a statistically significant improvement in postdidactic event core ophthalmology knowledge assessment scores ( p = 0.002). Conclusion Primary care NPs are increasingly the initial point of contact for patients with ophthalmic complaints, and thus, high-quality and thorough education regarding ophthalmology triage and referral for NPs is necessary. NP student comfort with and knowledge of ophthalmic complaints and triage may be improved by a brief educational intervention taught by an ophthalmologist early in the NP curriculum.

Self-directed learning: Alternative for traditional classroom learning in undergraduate ophthalmic education during the COVID-19 pandemic in China.

In recent years, the COVID-19 pandemic has led to a shift in medical education from traditional face-to-face to online or remote learning, which provided challenges to faculty and students that have traditionally given face-to-face instruction. Self-directed learning (SDL) has gained popularity in undergraduate education such as nursing and adult education. Although the application of SDL in many medical teachings is practical, the application of SDL in undergraduate ophthalmology education has not been well investigated. COVID-19 pandemic led to changes in the learning style of undergraduate medical students to adapt to the shift from traditional classroom learning (TCL) to online or remote learning. Self-directed learning is a process in which individuals take the initiative in diagnosing their learning needs, formulating learning goals, identifying resources for learning, choosing and implementing appropriate learning strategies and evaluating learning outcomes. This study compared students' perspectives and study outcomes of the SDL and TCL to preliminarily investigate the effect of SDL in undergraduate ophthalmology education. The students showed equal perspectives and satisfaction with both learning models. There was no difference in learning outcomes at the end of the study. The students with different interests in ophthalmology had different perspectives on SDL and TCL. Self-directed learning is an essential alternative to traditional classroom learning in undergraduate ophthalmic education during the COVID-19 pandemic in China.

Endoscopic endonasal dacryocystorhinostomy learning curve / Curva de aprendizagem de dacriocistorrinostomia endonasal endoscópica

ABSTRACT Purpose: To compare the learning curves of the specialists in two different fields without previous endoscopic endonasal dacryocystorhinostomy experience as well as to reveal the related complications with surgical success rates. Methods: We retrospectively investigated 90 patients who received consecutive endoscopic endonasal dacryocystorhinostomy with mucosa preservation by an ophthalmologist (Group 1, n=45) and an otorhinolaryngologist (Group 2, n=45) between October 2017 and October 2019. Patients who were admitted with epiphora complaints and diagnosed with primary acquired nasolacrimal duct obstruction through lacrimal irrigation test and aged >18 years with at least 6 months of follow-up were included in the study. In all cases, additional pathologies such as septum deviation were evaluated by performing maxillofacial imaging. Patients' medical records were evaluated in terms of surgery duration, complications, and functional achievements. Results: The mean surgical duration of the patients in Group-2 was 36.27 ± 11.61 min, while it was 43.62 ± 16.89 min in Group-1; the difference was statistically significant (p=0.018). Functional achievements in Group 1 was 84.4% (73.3% in the first set of 15 cases, 93.3% in the last set of 15 cases) in Group 2; this rate was 88.9% (80% in the first set of 15 cases, 93.3% in the last set of 15 cases), and the difference was not statistically significant (p=0.53). Septum intervention in addition to endoscopic surgery in both the groups (p=0.03, p=0.005, respectively) and intense bleeding during surgery (for both the groups, p<0.0001) significantly decreased the functional success. Conclusion: Endoscopic endonasal dacryocystorhinostomy, performed after the necessary training, can provide high success and low complication rates when even conducted by ophthalmologists who are unfamiliar with endoscopic surgery after an experience of 30 cases.

RESUMO Objetivos: O objetivo deste estudo é comparar as curvas de aprendizagem dos especialistas em dois campos diferentes sem experiência prévia de dacriocistorrinostomia endonasal endoscópica e revelar as complicações com as taxas de sucesso cirúrgico. Métodos: Foram investigados retrospectivamente 90 pacientes que receberam dacriocistorrinostomia endonasal endoscópica consecutiva com preservação da mucosa realizada por um oftalmologista (Grupo 1, n=45) e realizada por um otorrinolaringologista (Grupo 2, n=45) entre outubro de 2017 e outubro de 2019. Foram incluídos no estudo pacientes admitidos com epífora e diagnosticados com obstrução primária do ducto nasolacrimal adquirido como resultado do teste de irrigação lacrimal, com idade superior a 18 anos e com, pelo menos, 6 meses de acompanhamento. Em todos os casos, patologias adicionais, como o desvio do septo, foram avaliadas por meio da realização de imagens maxilofaciais. Os prontuários dos pacientes foram avaliados quanto à duração da cirurgia, complicações e desempenho funcional. Resultados: A média de duração cirúrgica dos pacientes no Grupo-2 foi de 36,27 ± 11,61 minutos, enquanto no Grupo-1 foi de 43,62 ± 16,89 minutos, sendo a diferença estatisticamente significativa (p=0,018). O desempenho funcional no Grupo 1 foi de 84,4% (73,3% nos primeiros 15 casos, 93,3% nos últimos 15 casos) no Grupo 2, essa taxa foi de 88,9% (80% nos primeiros 15 casos, 93,3% nos últimos 15 casos) e a diferença não foi estatisticamente significativa (p=0,53). A intervenção do septo além da cirurgia endoscópica em ambos os grupos (p=0,03, p=0,005, respectivamente) e sangramento intenso durante a cirurgia (para ambos os grupos, p<0,0001) diminuiu significativamente o sucesso funcional. Conclusão: A dacriocistorrinostomia endonasal endoscópica, realizada após o treinamento necessário, pode ser realizada com alto sucesso e com baixas taxas de complicações por oftalmologistas que não estão familiarizados com a cirurgia endoscópica após adquirirem experiência com trinta casos.

Ophthalmology Services at Student-Run Free Clinics: A National Survey.

IMPORTANCE: Student-run free clinics (SRFCs) primarily service the uninsured and are a unique way for medical students to gain hands-on exposure to ophthalmology. The free clinic model takes many different forms- some with episodic and longitudinal models-- and this is mirrored in corresponding eye services. OBJECTIVE: To describe SRFC ophthalmology services nationwide. DESIGN: This was a telephone survey study administered from June through July of 2018. SETTING: This study surveyed medical school SRFC clinics across the United States. PARTICIPANTS: Survey request was sent to 19 SRFCs previously identified as having ophthalmology services via internet search. Fourteen SRFCs (73%) participated; participants were either student clinic leaders or medical directors. One respondent no longer had a distinct eye clinic so was excluded from relevant results. MAIN OUTCOME AND MEASURE: Characteristics of ophthalmology SRFCs including participants, frequency of sessions, common diagnoses treated, and challenges encountered were assessed through this survey. RESULTS: On average, each SRFC provided 5.15 hours per month of ophthalmology services. The mean number of medical students involved per session was 8.7. Lack of infrastructure to ensure adequate patient follow-up and faculty recruiting were cited as the main challenges in providing ophthalmology services. Most SRFC leaders indicated exposure to ophthalmology and practice with the exam as the main experiences that students sought and achieved. The most common conditions treated were refractive error (92.3%) and diabetic retinopathy (69.2%). CONCLUSION: There are a small number of SRFCs that have ophthalmology services, and they share common features in terms of participants, staffing, and, barriers to sustainability. Ophthalmology services at SRFCs offer a unique venue for medical students to gain exposure to an under-represented field in medical school curricula. The growth of this critical venue for medical student training could be enhanced by recruitment strategies aimed at ophthalmology faculty with a strong interest in service and teaching.

Perfil e trajetória profissional dos egressos da residência médica em Oftalmologia do Estado de Alagoas / Profile and professional career of graduates from the Alagoas State Ophthalmology residency program

Resumo Objetivo: Caracterizar o perfil dos egressos de Programas de Residência Médica em Oftalmologia no Estado de Alagoas, quanto à sua formação e prática profissional. Métodos: Estudo descritivo, retrospectivo, de paradigma quantitativo, desenvolvido a partir de questionário autoaplicável enviado aos médicos egressos do programa de residência em Oftalmologia do Hospital Universitário Professor Alberto Antunes (HUPAA/UFAL) que finalizaram a residência nos últimos 10 anos. Resultados: Dos 28 ex-residentes, 27 responderam ao questionário. Foram predominantemente mulheres (70,4%), jovens (média 35,92±4,05 anos), de naturalidade alagoana (51,8%), com graduação em instituições públicas (81,5%). A maioria se fixou em Maceió e região metropolitana (51,8%) e trabalha em ambulatórios privados (92,6%), com pouca atuação na gestão (14.8%) e docência (7,4%). Mais da metade não possui titulação de especialista pelo Conselho Brasileiro de Oftalmologia (59,3%) e realizou programa de complementação especializada tipo "fellowship" (74%). Apenas 7,4% realiza atividades em pesquisa e 3.7% possui mestrado. No geral, os egressos estudados estão satisfeitos com o exercício da especialidade (100%) e com sua formação na instituição (86,3%), sugerindo melhora na assistência cirúrgica e ensino teórico (29,7%). Conclusão: A avaliação da realidade e atuação profissional dos egressos e de suas percepções foi capaz de levantar o perfil de escolhas profissionais e condições de inserção e satisfação profissional. Também permitiu avaliação externa complementar da instituição formadora, fornecendo subsídios para melhoria da qualidade dos programas de residência médica em Oftalmologia.

Abstract Objective: To characterize the profile of graduates of Medical Residency Programs in Ophthalmology in the state of Alagoas, regarding their training and professional practice. Methods: Retrospective descriptive study developed from a self-administered questionnaire sent to doctors who graduated from the Ophthalmology residency program at the Professor Alberto Antunes University Hospital (HUPAA / UFAL) who completed their residency in the last 10 years. Results: Of the 28 former residents, 27 responded to the questionnaire. They are predominantly women (70.4%), young (average 35.92 ± 4.05 years), born in the State of Alagoas (51.8%), graduated from public institutions (81.5%). Most settled in Maceió and the metropolitan region (51.8%) and work in private outpatient clinics (92.6%), with little experience in management (14.8%) and teaching (7.4%). More than half do not have a specialist degree from the Brazilian Council of Ophthalmology (59.3%) and carried out a specialized fellowship complementation program (74%). Only 7.4% carry out research activities and 3.7% have a master's degree. In general, the studied graduates are satisfied with the exercise of the specialty (100%) and with their training at the institution (86.3%), suggesting an improvement in surgical care and theoretical teaching (29.7%). Conclusion: The evaluation of the reality and professional performance of the graduates and their perceptions was able to raise the profile of professional choices and conditions of insertion and professional satisfaction. It also allowed complementary external evaluation of the training institution, providing subsidies for improving the quality of ophthalmology medical residency programs.

Microinvasive Glaucoma Surgical Training in United States Ophthalmology Residency Programs.

PURPOSE: The emergence of microinvasive glaucoma surgeries (MIGS) has expanded glaucoma management options. Resident experience with these novel procedures is unclear as no residency minimums exist for them, nor are they part of Accreditation Council for Graduate Medical Education (ACGME) procedure logs. The purpose of this study was to assess resident experience with MIGS in ACGME ophthalmology residency programs across the United States. METHODS: This was a cross-sectional survey study of resident MIGS experience. A survey was mailed to program directors of ACGME-accredited ophthalmology residency programs (N = 118) in January 2017. Descriptive analyses were used to characterize the respondent demographics. Chi-square, paired t-tests, and McNemar's tests were used to analyze the geographical distribution and frequency of MIGS experience. RESULTS: A total of 30 out of 118 (25%) residency program directors across all geographic regions responded. Most incorporated both MIGS lecture (87%) and wet lab (73%) didactics into their curriculum. Only 27% felt that MIGS should be part of ACGME requirements. The most common MIGS taught were iStent (70%), endoscopic cyclophotocoagulation (50%), and trabectome (40%). Few residents had completed MIGS procedures as the primary surgeon by graduation. Eleven out of 30 program directors (37%) did not feel that the experience was adequate for independent practice. CONCLUSION: This study suggests that residents are exposed to some MIGS procedures during training, but program directors did not feel that the experience was adequate for independent practice. Further research is necessary to understand the barriers to integrating MIGS training into residency programs.

Impact of Near-Peer Education in a Student-Run Free Ophthalmology Clinic on Medical Student Teaching Skills.

OBJECTIVE: To determine the impact of near-peer teaching experiences in the ophthalmology branch of the East Harlem Health Outreach Program (EHHOP), a student-run clinic, on teaching skills of fourth-year medical student Teaching Seniors (TS). DESIGN: Mixed-methods observational study, including online survey and telephone interview. SETTING: Student-run ophthalmology clinic affiliated with the Icahn School of Medicine at Mount Sinai and Mount Sinai Hospital, a tertiary-care center in New York, NY. PARTICIPANTS: All EHHOP TS alumni from 2014 to 2019 were eligible for inclusion in our study. All 14 alumni participated in the survey, and 8 participated in the follow-up interview. METHODS: EHHOP ophthalmology TS alumni were surveyed via an online survey and subsequent, optional, individual telephone interview. The web survey queried former TS on the impact of EHHOP ophthalmology experiences on self-reported teaching skills and comfort with teaching. Quantitative analysis of survey questions and qualitative analysis of telephone responses was performed and analyzed for themes. RESULTS: Majority of participants reported increased comfort teaching ophthalmology concepts, teaching the slit-lamp exam, and serving as mentors as a result of their experience. Qualitative analysis of telephone interviews revealed 4 major themes: (1) TS were a self-selected group of individuals with prior interest in teaching, (2) Teaching experiences in EHHOP had a positive impact in many teaching-related domains, (3) TS perceptions of teaching skills gained did not necessarily align with junior students' perceptions of teaching received, and (4) despite increased confidence and satisfaction with teaching experiences, TS desired more formal instruction in teaching. CONCLUSIONS: While TS perceptions of teaching skills gained in EHHOP ophthalmology were overwhelmingly positive, TS still desired formal instruction in teaching. Additionally, the effectiveness of near-peer education in a subspecialty like ophthalmology, with limited formal curricular time, may be more effective later in training, when a more solid foundation of knowledge is acquired.

Ophthalmology resident surgical training: Can we do better?

In ophthalmology, surgical skills training is challenging for both teachers and residents. Teaching in an operating room is complicated by the fact that the attending faculty member is primarily an observer with limited ability to prevent surgical complications. With the recent modifications in residency curricula which include virtual reality surgical simulation and wet labs, the technical skills and clinical judgment can be taught and assessed without exposing the patient to extra risk. In this review, guidelines are suggested to improve the process of training during residency and they can be applied to all ophthalmic surgical training.

Seven- and eight-year trends in resident and fellow glaucoma surgical experience.

PURPOSE: This study evaluated US resident and fellow glaucoma surgical experience over a 7- and 8-year period, respectively. METHODS: US ophthalmology resident glaucoma case logs from 2009 to 2016 and glaucoma fellow case logs from 2008 to 2016 were reviewed. The number of total, average, median, and minimum cases, along with percentile data for filtering surgery, shunting surgery, and novel procedures were analyzed for year-to-year trends. RESULTS: Among residents training from 2009 to 2016, there was a decline in the average number of primary filtering surgeries by 20%, from 6.0±5.0 to 4.8±4.0 cases, with a concurrent increase in average primary glaucoma drainage implant (GDI) surgeries by 40%, from 4.5±4.0 to 6.3±5.0 cases, which represented an increase of 6.5% per year, P<0.001. Glaucoma fellow data from 2008 to 2015 demonstrated a decline in average primary trabeculectomy surgeries by 3.7%, from 30.1 to 29.0 cases, but then increased to 32.1 cases in 2015-2016. There was an increase in average GDI surgeries by 57.9%, from 30.2 to 47.7 cases for fellows over this 8-year period, which represented a 5.9% increase per year, P<0.001. There was no microinvasive glaucoma surgery (MIGS) or other novel procedures reported in the Accreditation Council for Graduate Medical Education (ACGME) resident case logs. From 2008 to 2016, Association of University Professors of Ophthalmology (AUPO) glaucoma fellow case logs demonstrated an increase in endocyclophotocoagulation (ECP) from 2.3 to 5.4 cases, a 15.5% increase per year, P<0.001. CONCLUSIONS: Over a 7-8-year period, trainee surgical experience with GDI surgery has steadily increased, whereas surgical experience with trabeculectomy has been fluctuating and may be on a downward trend. Educators should be aware of shifts in trainee surgical experience in order to maintain appropriate training experience.

Early Performance on an Eye Surgery Simulator Predicts Subsequent Resident Surgical Performance.

OBJECTIVE: To examine early performance on an eye surgery simulator and its relationship to subsequent live surgical performance in a single large residency program. DESIGN: Retrospective study. SETTING: Massachusetts Eye and Ear, Harvard Medical School, Department of Ophthalmology. METHODS: In a retrospective study, we compared performance of 30 first-year ophthalmology residents on an eye surgery simulator to their surgical skills as third-year residents. Variables collected from the eye surgery simulator included scores on the following modules of the simulator (Eyesi, VRmagic, Mannheim, Germany): antitremor training level 1, bimanual training level 1, capsulorhexis level 1 (configured), forceps training level 1, and navigation training level 1. Subsequent surgical performance was assessed using the total number of phacoemulsification cataract surgery cases for each resident, as well as the number performed as surgeon during residency and scores on global rating assessment of skills in intraocular surgery (GRASIS) scales during the third year of residency. Spearman correlation coefficients were calculated between each of the simulator performance and subsequent surgical performance variables. We also compared variables in a small group of residents who needed extra help in learning cataract surgery to the other residents in the study. MAIN OUTCOME MEASURES: Relationships between Eyesi scores early in residency and surgical performance measures in the final year of residency. RESULTS: A total of 30 residents had Eyesi data from their first year of residency and had already graduated so that all subsequent surgical performance data were available. There was a significant correlation between capsulorhexis task score on the simulator and total surgeries (r = 0.745, p = 0.008). There was a significant correlation between antitremor training level 1 (r = 0.554, p = 0.040), and forceps training level 1 (r = 0.622, p = 0.023) with primary surgery numbers. There was a significant correlation between forceps training level 1 (r = 0.811, p = 0.002), and navigation training level 1 (r = 0.692, p = 0.013) with total GRASIS score. There was a significant inverse correlation between total GRASIS score and residents in need of extra help (r = -0.358, p = 0.003). CONCLUSION: Module scores on an eye surgery simulator early in residency may predict a resident׳s future performance in the operating room. These scores may allow early identification of residents in need of supplemental training in cataract surgery.

Avaliação do conhecimento de médicos com especialidade em clínica médica e clínica cirúrgica sobre o processo de doação de córneas / Evaluation of knowledge of physicians with specialty in medical clinic and surgical clinic about the process of corneas donation

Resumo Objetivo: Este trabalho tem como objetivo avaliar o conhecimento de médicos com formação nas especialidades de clínica médica e cirúrgica acerca do processo de doação de córneas, bem como avaliar a segurança por parte desses profissionais neste processo e, se há insegurança, os motivos para tal. Métodos: A pesquisa se baseia na coleta de dados por meio de um questionário com dez perguntas de múltipla escolha sobre o processo de doação de córneas, sendo duas perguntas sobre segurança no processo de doação. A amostra consiste em 60 profissionais médicos do Hospital Universitário HU-UFSC selecionados por conveniência e não probabilística. Resultados: Os entrevistados obtiveram uma média de acertos de 72,2%. Em relação à segurança no processo de doação de córneas, 41 (68,66%) referem se sentir seguros quanto ao mesmo e 19 (31,33%) revelam não ter segurança para essa condição. Do total de entrevistados que revelaram insegurança no processo de doação de córneas, 13 apontaram como fator contribuinte pouca informação sobre o assunto na faculdade. Alguns temas relevantes a respeito do assunto se mostraram insuficientes e 31,66% dos entrevistados se revelaram inseguros frente a uma situação que envolva doação de córneas. Conclusão: Esses achados sugerem a necessidade de melhorar o nível de informação transmitida durante o curso de graduação acerca do processo de doação de córneas, a fim de conscientizar, melhorar o conhecimento e promover segurança frente a um potencial doador.

Abstract Objective: This study aims to evaluate the knowledge of physicians trained in Internal medicine and General surgery specialties about cornea donation process clinic, as well as to assess the confidence by these professionals in this process and, if there is uncertainty, the reasons for this. Methods: The research is based on data collected through a questionnaire with ten multiple choice questions about the process of cornea donation, in which two questions are about confidence in the donation process. The sample consists of 60 physicians of University Hospital HU-UFSC selected for convenience and non-probability. Results: Respondents had a mean score of 72.2%. Regarding confidence in the donation of corneas, 41 (68.66%) feel confident in the donation process and 19 (31.33%) did not reveal safety for this condition. From the total of respondents who revealed insecurity in cornea donation process, 13 of these indicated as a contributing factor little information on the subject in college. Some relevant themes on the subject are insufficient and 31.66% of the interviewees proved insecure against a situation involving the corneal donation. Conclusion: This finds suggest the need to improve the level of information transmitted during the undergraduate course about the process of corneal donation in order to raise awareness, improve knowledge and promote confidence when facing a potential donor.