Christiane Isolde Falkner-Radler, MD
Associate Professor of Opthalmology
The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Laser surgery, Department of Ophthalmology, Rudolf Foundation Clinic, Vienna, Austria
Needle Size in Intravitreal Injections-Preliminary Results of a Randomized Clinical Trial.
To evaluate the influence of the needle size used for intravitreal (IVT) injections on patients` pain experience in a randomized, double-armed, single-blinded, single-centered clinical trial.
Patients included were randomized to have an IVT injection performed with a 27-gauge needle (group 1) or with a 30-gauge needle (group 2). The topical anesthesia before the injection was standardized (0.5% tetracaine drops). Immediately after the injection, patients were asked to grade their pain using the visual analogue scale (VAS) and the Wong-Baker FACES scale. The main outcome measure was the pain score assessment. Co-factors analyzed were patients’ demographics (age and gender), clinical characteristics including right eye, left eye and number of previous IVT injections, and the surgeon. In addition, scaled surgeon’s questionnaires to asses the IVT injection procedure were evaluated. For statistical analysis a regression model was used.
Up to now, the data of 126 patients were analyzed. Fifty nine patients were included in group1 and 67 patients in group 2. Mean VAS pain scores were 2.26 ± 1.35 for group 1 and 2.27 ± 1.66 for group 2. Mean Wong-Baker pain scores were 1.95 ± 1.51 for group 1 and 2.22 ± 1.65 for group 2. There was no significant difference in the VAS pain scores (p> 0.86) and in the Wong Baker pain scores (p> 0.36) between both treatment groups. Gender and the number of previous IVT injections significantly influenced the VAS pain scores (p< 0.05), whereas age had a significant influence on the Wong Baker pain scores (p< 0.20). Female patients, patients with a history of previous IVT injections and older patients had higher pain scores. The surgeon’s questionnaire showed an overall preference towards the use of a 30-gauge needle for IVT injections.
The use of a 30-gauge needle for IVT injections showed no significant effect in pain relief compared to the use of a 27-gauge needle. However, a 30-gauge needle was preferred by all surgeons.
Matus Rehak, MD, PhD
Time effort of preparation for the cataract surgery in different European countries
Purpose: To compare the time necessary for different ophthalmic investigations and preparation of patients before the cataract surgery in different European countries.
Methods: The ophthalmic investigations and preparations of patients for the cataract surgery were divided into the 8 steps: visual acuity, intraocular pressure, slit lamp, biomicrospocy of the fundus in mydriasis, biometry and IOL calculation, inform consent, consent for the anesthesia, and appointment administration. The time necessary for each single step were measured separately if performed by ophthalmologist and separately if the step was done by nurse, optician or optometrist. The measurements were performed in at least 6 patients in four different University Departments of Ophthalmology in four different European countries: Germany, Finland, Czech Republic and Russia. The waiting time between the steps was not reflected. The differences among these countries were compared.
Results: The longest total time for all evaluated steps was found in Finland (53 ± 8 min) followed by Germany (47 ± 9 min) and Czech Republic (37 ± 7 min). The shortest total time was observed in Russia (32 ± 6 min). Further, significant differences were found in total time, which the ophthalmologist spends for the preparation of the cataract surgery. The highest volume of the preparation was performed by ophthalmologist in Germany and Finland. In Czech Republic nd in Russia significantly more steps are done by nurses or optician.
Conclusions: Even the cataract surgery is a highly standardized procedure; the preparation of the patient varies significantly among different European countries. The shortest total time as well the smallest proportion of the time performed by ophthalmologist was found in Russia.
New Requirements for Ophthalmology Residents in Sweden
In 2008, the National Board of Health and Welfare in Sweden approved new regulations regarding the Swedish program for residents. These regulations specify what skills and knowledge residents have to possess in order to become a specialist in their respective specialties.
In contrast to the older regulations, two new chapters were included in the new plan, i.e. a research project and a quality project. The requirements of these new chapters are vaguely described concerning the extent of the projects, time needed to complete them or how they should be presented. Thus, it is not clear how they are supposed to be executed practically.
In this EuLDP project, the requirements of the new chapters will be standardized for the field of ophthalmology. This is accomplished by a survey of regulations made by government and other medical specialty societies in Sweden. This document is now completed and approved by the Swedish Ophthalmological Society, and it is from now on the standard regarding the research and quality projects for residents in ophthalmology in Sweden.
Miltiadis K. Tsilimbaris
Organization of the ICO Two days Ophthalmology Residency Program Directors Course in Crete, Greece
Purpose of the project was to organize the first ICO Two Days Ophthalmology Residency Program Directors Course in Greece.
The International Council of Ophthalmology (ICO) has a long experience in Residency Programs Directors Educational Courses all over the world. The interactive approach of these courses has allowed participants to acquire practical information and skills, and improves their residency-training program. Several countries have formed residency program directors’ groups to continue efforts in enhancing resident education.
The Residency Program Director’s Course was designed to improve the participants teaching and assessing effectiveness. Valuable presentations took place and resources related to new methodologies of residency training were presented.
The Course was successfully organized by the ICO with the support of the University Eye Clinic of Heraklion, Crete and the Confederation of the Greek Ophthalmological Societies.
The course took place in Hersonissos, Heraklion, Crete, Greece, on October 3-4, 2011, just prior to EVER Meeting The course was based on active participation. Teaching methods included lecture (25%), small group discussion (35%), and large group discussion (40%). Major topics included adult learning principles, curriculum design, resident assessment and improving teaching skills.
Ophthalmologists from Greece and other European countries involved in training programs participated in the course and benefited through the presentations, resources and discussions with colleagues.