Perspectives of Ophthalmologists on Managing Patient Expectations and Improving Patient Satisfaction

To achieve a high level of patient satisfaction, physicians need to identify and address patients' expectations. However, ophthalmologists' attitudes and behavior with respect to patient expectations and satisfaction are not well understood. Therefore, we under took a study to examine ophthalmologists' attitudes, performance and major determinants of their behavior with respect to managing patient expectations in different settings: public hospitals and private clinics.

The authors refined a previously validated questionnaire to assess ophthalmologists' attitudes and performance with respect to patient expectations and patient satisfaction in public hospitals and private clinics. The authors surveyed ophthalmologists at the Annual Conference of Ocular Microsurgery in Israel.

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Review: Measurement Techniques for Intraocular Pressure

It is important to determine the intra-ocular pressure, the fluid pressure inside the eye, in order to evaluate for patients at risk from glaucoma, because of potential damage to the optic nerve. 

Tonometers are calibrated to measure pressure in millimeters of mercury [mmHg]. There are many different types of tonometers, including Schiotz, Goldmann, Perkins, Marg-MacKay, Air-Puff (American Optical), and the new “Triggerfish” wireless contact lens (Sensimed AG). Preliminary mechanics and development work in this area was presented by Friedenwald. This list is certainly not exhaustive, as there are many new devices developed in recent years, including the Tono-Pen, ocular bounce, resonant tonography, and dynamic pascal tonometry.

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Cornelia de Lange Syndrome with Congenital Glaucoma

Cornelia De Lange syndrome (CDLS), also known as Brachmann de Lange syndrome is a rare syndrome. It is characterised by distinctive facial dysmorphism, growth retardation,developmental delay, upper limb reduction defects, gastroesophageal dysfunction, ophthalmologic and genitourinary anomalies, hirsutism, pyloricstenosis, congenital diaphragmatic hernias, cardiac septal defects, and hearing loss. The syndrome was first described by a Dutch paediatrician named Cornelia de Lange, in 1933.

Though the genetic basis of this syndrome is not clear, a majority of cases are due to spontaneous mutations. The defective gene can be inherited from either parent, making it autosomal dominant type of inheritance.

Synophrys, long curled lashes, myopia, and hypertrichosis of the brows. These patients have also been found to have ptosis, epiphora, nasolacrimal duct obstruction, and micro cornea, congenitalglaucoma, corneal opacities, iris heterochromia and optic nerve head pallor/atrophy.

Human Turbinate-derived Mesenchymal Stem Cells Differentiated into Keratocyte Progenitor Cells

Though keratoplasty is used to treat corneal blindness, donor shortage, tendency of stimulated keratocyte transformed to fibroblast and immunological rejection are still big problems. As a solution, cornea tissue engineering using non-corneal tissue sourced cells become emerging issue. Thus, this study was designed to find novel material for keratoplasty.

Human turbinate-derived mesenchymal stem cells (hTMSCs) were obtained from patients and cultured with differentiation medium for 14 days. The keratocyte markers, stem cell markers, early corneal stromal stem cell (CSSC) markers, were measured by real time-PCR. The MSC markers were detected by FACS. Results: After 14 days of differentiation medium exposure, hTMSCs expressed markers of keratocyte such as keratocan sulfate proteoglycan (KERA) and aldehydrogenase (ALDH). As the hTMSCs became keratocytes, the expression of embryonic ocular precursor markers ABCG2 and PAX6 decreased but were still measurable. Early CSSC markers including SIX2, SIX3, BMI expression was elevated after 7 d and reduced after 14 d of KDM treatment.

Review: Measurement Techniques for Intraocular Pressure

The literature on intra-ocular pressure dynamics is reviewed, including tonometer design and calibration, the influence of corneal-scleral mechanics, and scleral rigidity factors. Drugs that influence the outflow facility of the trabecular mesh work (TM) are discussed. Transmural pressure drop across the lamina cribosa (LC) is an important parameter, in terms of quantifying potential glaucoma damage to the optic nerve.

It is important to determine the intra-ocular pressure, the fluid pressure inside the eye, in order to evaluate for patients at risk from glaucoma, because of potential damage to the optic nerve. Tono meters are calibrated to measure pressure in millimeters of mercury [mmHg]. There are many different types of tonometers, including Schiotz, Goldmann, Perkins, Marg-MacKay, Air-Puff (American Optical), and the new “Triggerfish” wireless contact lens (Sensimed AG). Preliminary mechanics and development work in this area was presented by Friedenwald. 

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Higher Axial Length and Flatter Cornea in Primary Open Angle Glaucoma than in the Age Related Glaucoma Cases

Glaucoma is a leading cause for the blindness globally and 79.6% millions might be affected by Open Angle Glaucoma (OAG) and Angle Closure Glaucoma (ACG) by the year 2020. 74% of these patients may be diagnosed OAG and 47% of the Asian population are affected by it. A study among the 209 patients revealed higher axial length and flatter Cornea among the patients affected by POAG than the age-matched control group.

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The Disease Course of Bilateral Endogenous Fungal Endophthalmitis

To report the dynamic disease course of a case of bilateral endogenous fungal endophthalmitis, which was successfully treated? Case Report: A 54 year old Chinese man with a history ofextracorporeal shock wave lithotripsy (ESWL) and ureteroscopy was referred to our center. After 1 week, his best corrected Snellen visual acuity (BCVA) values were 20/100 and 20/25; the interface between the posterior vitreous face and the retinal surface appeared to be rough in the right eye, and a similar, larger, low-rounded circumscribed apophysis could be observed in the left eye.

During the 2nd week, his BCVA values decreased to 20/400 and 20/32. He was diagnosed with bilateral endogenous Candida albicans endophthalmitis after a vitreous biopsy and then underwent binocular pars plana vitrectomy (PPV) with silicone oil injection in both eyes. Post operatively, his BCVA values were 20/63 and 20/32, and fundoscopy and optical coherence tomography (OCT) showed a regular and smooth interface and retina surface after the removal of the silicone oil at 3 months. 

Inter pupillary Distance Measurements among Students in the Kumasi Metropolis

Inter pupillary distance has been defined by various authors as the distance between the centres of the pupils in millimetres. It is abbreviated as PD, or more correctly, IPD. IPD is the most important inter orbital parameter for measuring the distance between the eyeballs. The clinical importance of IPD is to facilitate the correct positioning of ophthalmic lenses before the eyes to eliminate unwanted strain on the eyes due to induced prismatic effects from the lenses.

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The Effects of Intense Pulsed Light on Tear Osmolarity in Dry Eye Disease

In this prospective study we show the influence of Intense Pulsed Light Therapy (IPL) on tear osmolarity, an increasingly important metric of dry eye disease. Previous studies have measured the effectiveness IPL has had on other metrics including tear break up time (TBUT), lipid layer grade (LLG), tear evaporation rate (TER), tear meniscus height (TMH), and subjective responses from patients.

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Further Research needed to explore the link between Posterior keratoconus and Ocular coloboma

Posterior keratoconus is a rare corneal disorder that results in non-inflammatory thinning of the cornea, leading to cone-like protuberance in the posterior cornea. Ocular coloboma is malformation due to faulty closure of the embryonic fissure, where the entire ocular structure may affect iris, ciliary body, choroid, optic nerve or all of the above. Posterior keratoconus may lead to vision loss over a period of time. A rare case of both Posterior keratoconus along with Ocular coloboma was presented here. The study predict genetic linkage as one of the reasons and suggest further studies to explore the link between Posterior keratoconus and the Ocular coloboma.

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Scleral Lenses and Irregular Corneas: Patient versus Practitioner Goals

For more than 25 years, my clinical care for the most part has involved providing vision care for individuals with Keratoconus and other types of irregular cornea. What I have come to appreciate is that what the patient seeks to achieve is often very different from what we as eye care providers are looking to accomplish.

First and foremost, individuals who have learned that they suffer from some sort of corneal irregularity that has begun to interfere with their vision, are simply seeking to address that very issue, their vision. Their other concern is that they are not “going to go blind” from the condition. They don’t think about how the selection and application of a vision care correction might adversely affect their future ocular health.

Advanced Case of Rhabdomyosarcoma of Orbit Mimicking Orbital Cellulitis

Rhabdomyosarcoma is a malignant neoplasm of primitive mesenchyme exhibiting skeletal muscle differentiation. Rhabdomyosarcoma, which can histo pathologically be of embryonal, alveolar, botryoid and pleomorphic types; is a rare tumor in children, with an annual incidence of 4.3 cases per million. Pleomorphic rhabdomyosarcomas is a rare variant, occurring more commonly in adults. 

We report a rare case of ocular pleomorphic rhabdomyosarcoma in an 18-month-old child with atypical presentation mimicking orbital cellulitis. A provisional diagnosis of orbital cellulitis was made based on clinical and radio logical examination and was planned for surgery. Histopathology confirmed the diagnosis of pleomorphic rhabdomyosarcoma. This case shows that pleomorphic rhabdomyosarcoma may also occur in children, it may mimic symptoms of orbital cellulitis, and any fast growing swelling should be carefully examined with a high degree of suspicion of this entity.

Keratoconus Management: Role of GP Contact Lenses

Keratoconus is a corneal disorder progressive characterized by thinning and steepening of the central and paracentral cornea, which leads to protrusion. The exact cause of the disease remains to be fully elucidated although its etiology probably is multi factorial with a genetic predisposition to keratoconus influenced by external environmental factors (eye rubbing and atopy) with different systemic involvement. In the early stages, keratoconus can be managed with spectacles or contact lenses (CL), but when keratoconus progresses, other surgical techniques are often required.

For example, anterior lamellar (dDALK) or penetrating keratoplasty (PK) permit than 3 of 4 patients achieve best-corrected visual acuity of 20/40 or better. Intra corneal ring segment(ICRS) are proposed to increase corneal stability and decrease the astigmatism a symmetry normalizing the corneal contour with slight improvement of patients’visual acuity. Corneal collagen cross-linking (CXL) is a common technique proposed to reduce disease progression with a light improvement of visual acuity (1 to 2 Snellen lines).

Efficacy and safety of the collagen-based Ologen implant as an adjuvant therapy in trabeculectomy for African American Population

Trabeculectomy remained as the most popular surgical treatment for glaucoma since early 60s. A study that tried to assess the efficacy and safety of the collagen-based Ologen implant compared tomitomycin-C (MMC) in a predominantly African American patient population. The study found Ologen as more effective and safe to treat glaucoma compared to mitomycin-C for the Afro-Americans as it could exhibit lower rates of adverse events as compared to MMC.

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Interpupillary Distance Measurements among Students in the Kumasi Metropolis

Interpupillary distance has been defined by various authors as the distance between the centres of the pupils in millimetres. It is abbreviated as PD, or more correctly, IPD. Normal values of IPD for the Ghanaian student population have been established. The IPD values are relevant for the manufacture of spectacles corrections for the Ghanaian student population. Different experimental techniques, differences in sample sizes, differences in age ranges and limited background information about study subjects hinder the generalization of IPD values for different sets of people from different ethnic backgrounds.

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Corneal lenticules as a Surgical Option to close corneal perforation

Corneal perforation is a disorder that affects anterior chamber of the cornea, is caused mainly due to bacterial infection. Surgical and non-surgical therapeutic options are considered to close the perforation to prevent the collapse anterior chamber and to restore the visual functions. In the worst scenario, it may lead to irreversible angle-closure glaucoma, which may lead to blindness. Corneal lenticules is a safe surgical adjuvant method for corneal perforation closure.

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