A survey of perceptions of exposure to new technology in residents and practicing ophthalmologists.

BACKGROUND: Incorporation of the rapid advances in ophthalmologic surgical and diagnostic techniques inherent in the field poses a challenge to residency training programs. This study investigates exposure to new technologies during residency and perception of its impact on practice patterns. METHODS: Ophthalmology residents at various training levels and practicing ophthalmologists who had completed their training were invited to participate in a survey study assessing exposure to various technologies in residency and in practice. Data collection occurred from December 2022 to June 2023. Descriptive statistics were performed. RESULTS: The study received 132 unique responses, including 63 ophthalmology residents and 69 practicing ophthalmologists. 65.2% (n = 45) of practicing ophthalmologists and 47.6% (n = 30) of current residents reported discussion/training on newly developed products on the market (e.g. premium IOLS, MIGS), was "minimally discussed but not emphasized" or "not discussed at all" in residency. 55.1% (n = 38) of practicing ophthalmologists reported that exposure to new technologies during residency did influence types of technologies employed during practice. The majority resident physicians reported enjoying being trained on newer technology and feeling more prepared for future changes in the field (95.2%, n = 60) and felt that having industry partnerships in residency enhances education and training (90.5%, n = 57). CONCLUSIONS: Considering how to maximize exposure to newer technologies/devices during residency training is important, and may contribute to training more confident, adaptable surgeons, who are more likely to critically consider new technologies and adopt promising ones into their future clinical practice.

Survey of Ophthalmology Training Experiences Among Young Ophthalmologists in the Asia-Pacific.

PURPOSE: To describe ophthalmology training experiences across the Asia-Pacific (APAC). DESIGN: Survey study. METHODS: We utilized an anonymous online survey, which was previously validated and conducted in Europe, through Young Ophthalmologist leaders from the national member societies of the Asia-Pacific Academy of Ophthalmology (APAO) from September 2019 to July 2021. Responses were based on a 5-point Likert scale (where applicable) and data were analyzed using Microsoft Excel. Our main outcome measures were differences between regions, that is, Southeast Asia (SEA) and Western Pacific (WP); and seniority, that is, trainees/junior ophthalmologists and senior ophthalmologists. RESULTS: We collated 130 responses representing 20 regions in the APAC region. The year of completion of ophthalmic training ranged from 1999 to 2024. The mean duration of training was 3.7±1.0 years. Most (98/130, 75%) indicated an interest for a common training standard across the APAC. Comparing SEA and WP trainees, both regions had similar working environments, but those in SEA reported significantly lower remuneration than their counterparts in WP ($600 vs $3000, P <0.05). WP trainees performed more phacoemulsification surgeries (76 WP vs 19 SEA), while SEA trainees conducted more manual small incision cataract surgeries (157 WP vs 1.5 SEA per duration of training). Senior ophthalmologists performed more cataract surgeries (210.9 senior ophthalmologists vs 40.1 junior ophthalmologists). Trainees had less confidence in medical competency areas such as interpreting an electroretinogram/visual evoked potential/electrooculogram (SEA=1.8, WP=2.1) and conducting an angiography (SEA=2.8, WP=3.4). CONCLUSIONS: Our study highlighted heterogeneity among ophthalmology training experiences in the APAC region, with the majority indicating an interest in a common training standard.

Detection of oedema on optical coherence tomography images using deep learning model trained on noisy clinical data.

PURPOSE: To meet the demands imposed by the continuing growth of the Age-related macular degeneration (AMD) patient population, automation of follow-ups by detecting retinal oedema using deep learning might be a viable approach. However, preparing and labelling data for training is time consuming. In this study, we investigate the feasibility of training a convolutional neural network (CNN) to accurately detect retinal oedema on optical coherence tomography (OCT) images of AMD patients with labels derived directly from clinical treatment decisions, without extensive preprocessing or relabelling. METHODS: A total of 50 439 OCT images with associated treatment information were retrieved from databases at the Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark between 01.06.2007 and 01.06.2018. A CNN was trained on the retrieved data with the recorded treatment decisions as labels and validated on a subset of the data relabelled by three ophthalmologists to denote presence of oedema. RESULTS: Moderate inter-grader agreement on presence of oedema in the relabelled data was found (76.4%). Despite different training and validation labels, the CNN performed on par with inter-grader agreement in detecting oedema on OCT images (AUC 0.97, accuracy 90.9%) and previously published models based on relabelled datasets. CONCLUSION: The level of performance shown by the current model might make it valuable in detecting disease activity in automated AMD patient follow-up systems. Our approach demonstrates that high accuracy is not necessarily constrained by incongruent training and validation labels. These results might encourage the use of existing clinical databases for development of deep learning based algorithms without labour-intensive preprocessing in the future.

Remote Surgeon Virtual Presence: A Novel Telementoring Method for Live Surgical Training.

PURPOSE: We describe the first known use of telementoring in corneal surgery and technology combining a 3-dimensional microscope system, 5G live streaming technology, group chat software, and a virtual reality headset for intercontinental surgical supervision. METHODS: Three surgeons in Toronto were proctored by a surgeon in Israel in the implantation of a novel keratoprosthesis device (CorNeat KPro; Ra'anana, Israel) into cadaver eyes. In Toronto, the NGENUITY platform (Alcon) transmitted high-definition, 3-dimensional images to the proctor in Israel who viewed the live video through a GOOVIS Virtual Reality headset with subsecond latency. This was made possible by the LiveU technology (Hackensack, NJ), which is a portable device to increase the bandwidth of transmission. The primary outcome was the successful completion of CorNeat KPro implantation. After each procedure, all surgeons completed a Likert scale questionnaire that assessed opinions on telementoring. RESULTS: All participants implanted the CorNeat KPro device. There was significant satisfaction reported. A total cumulative score from the questionnaire was 149 of 150 from the operating surgeons, with a score of 135 of 150 by the proctor. All felt that there was excellent AV quality with no lag time and recommended the technology. CONCLUSIONS: Telementoring is a promising tool that can traverse large distances for ophthalmic education.

Estimating the cost of training an ophthalmologist in Brazil / Estimativa do custo para formação de um oftalmologista no Brasil

ABSTRACT Introduction: It is estimated that 23% of the Brazilian population does not have access to an ophthalmologist, mainly because of the irregular geographical distribution of experts. It may be expensive to train ophthalmologists in Brazil. Objective: To estimate the cost of training an ophthalmologist and the labor market conditions so that the provider recovers the investment. Methods: Epidemiological study in databases from governmental sources and institutions related to the eye health system regulation. Results: The cost for training an ophthalmologist would be equal to R$ 592.272,00. After specialization, if the provider pledged all his/her income to recover the amount spent on training, it would take 5.2 years to reach the point of equilibrium. Conclusion: Young doctors from families unable to afford the cost of their education and support for at least 14 years after the beginning of the undergraduate course will hardly be able to specialize in Ophthalmology if they are unable to carry out their studies in public educational institutions. And those who can specialize are likely to choose to practice their profession in large urban centers, where most of the job opportunities are available, to at least recover the financial investment in training in the medium term.

RESUMO Introdução: Estima-se que 23% da população brasileira não tenha acesso ao oftalmologista, devido, principalmente, à falta de recursos do Sistema Público de Saúde e à distribuição geográfica irregular dos especialistas. É possível que seja caro formar oftalmologistas no Brasil. Assim, é compreensível que a maioria dos profissionais optem para ficar próximos dos grandes centros consumidores, onde estão as melhores remunerações. Objetivo: Estimar o custo para a formação de um oftalmologista e as condições do mercado de trabalho para que ele recupere o investimento. Métodos: estudo epidemiológico em bases de dados de fontes governamentais e de instituições relacionadas à regulamentação do sistema de saúde ocular. Resultados: Estimou-se que o custo para formação de um oftalmologista seja de R$ 592.272,00. Após a especialização, caso ele empenhe todo seu rendimento para reaver o valor gasto em sua formação, precisaria de 5,2 anos para atingir o ponto de equilíbrio. Conclusão: Jovens médicos oriundos de famílias incapazes de arcar com o custo de sua formação e de seu sustento, por pelo menos 14 anos após o início da graduação, dificilmente conseguirão se especializar em Oftalmologia, se não conseguirem realizar seus estudos em instituições públicas de ensino. E aqueles que conseguem se especializar, provavelmente optem por exercer a profissão em grandes centros urbanos, onde está a maior parte das oportunidades de trabalho, a fim de, a médio prazo, conseguir, pelo menos, recuperar o investimento financeiro na formação.

A Novel Virtual Wet Lab-Using a Smartphone Camera Adapter and a Video Conference Platform to Provide Real-Time Surgical Instruction.

PURPOSE: Proctored surgical instruction has traditionally been taught through in-person interactions in either the operating room or an improvised wet lab. Because of the COVID-19 pandemic, live in-person instruction was not feasible owing to social distancing protocols, so a virtual wet lab (VWL) was proposed and implemented. The purpose of this article is to describe our experience with a VWL as a Descemet membrane endothelial keratoplasty (DMEK) skills-transfer course. This is the first time that a VWL environment has been described for the instruction of ophthalmic surgery. METHODS: Thirteen participant surgeons took part in VWLs designed for DMEK skills transfer in September and October 2020. A smartphone camera adapter and a video conference software platform were the unique media for the VWL. After a didactic session, participants were divided into breakout rooms where their surgical scope view was broadcast live, allowing instructors to virtually proctor their participants in real time. Participants were surveyed to assess their satisfaction with the course. RESULTS: All (100%) participants successfully injected and unfolded their DMEK grafts. Ten of the 13 participants completed the survey. Respondents rated the experience highly favorably. CONCLUSIONS: With the use of readily available technology, VWLs can be successfully implemented in lieu of in-person skills-transfer courses. Further development catering to the needs of the participant might allow VWLs to serve as a viable option of surgical education, currently limited by geographical and social distancing boundaries.

Learning curve evaluation upskilling retinal imaging using smartphones.

Smartphone-based fundus imaging (SBFI) is a low-cost approach for screening of various ophthalmic diseases and particularly suited to resource limited settings. Thus, we assessed how best to upskill alternative healthcare cadres in SBFI and whether quality of obtained images is comparable to ophthalmologists. Ophthalmic assistants and ophthalmologists received a standardized training to SBFI (Heine iC2 combined with an iPhone 6) and 10 training examinations for capturing central retinal images. Examination time, total number of images, image alignment, usable field-of-view, and image quality (sharpness/focus, reflex artifacts, contrast/illumination) were analyzed. Thirty examiners (14 ophthalmic assistants and 16 ophthalmologists) and 14 volunteer test subjects were included. Mean examination time (1st and 10th training, respectively: 2.17 ± 1.54 and 0.56 ± 0.51 min, p < .0001), usable field-of-view (92 ± 16% and 98 ± 6.0%, p = .003) and image quality in terms of sharpness/focus (p = .002) improved by the training. Examination time was significantly shorter for ophthalmologists compared to ophthalmic assistants (10th training: 0.35 ± 0.21 and 0.79 ± 0.65 min, p = .011), but there was no significant difference in usable field-of-view and image quality. This study demonstrates the high learnability of SBFI with a relatively short training and mostly comparable results across healthcare cadres. The results will aid implementing and planning further SBFI field studies.

Estrategia de superación para el mejoramiento del desempeño profesional de oftalmólogos de la Atención Primaria de Salud en Santiago de Cuba / Training strategy for improving the professional performance in primary health care ophthalmologists in Santiago de Cuba

El vertiginoso desarrollo científico - tecnológico de la oftalmología requiere de una actualización sistemática desde el punto de vista teórico - práctico. A tales efectos, se diseñó una estrategia de superación para el mejoramiento del desempeño profesional de los oftalmólogos de la Atención Primaria de Salud dirigida a la atención integral de los pacientes con oclusiones vasculares retinianas. Se emplearon métodos de los niveles teórico y empírico. Fue diseñada en 4 etapas y se utilizó el ciclo Deming como referente metodológico. Se establecieron relaciones esenciales que ofrecen coherencia lógica interna a la educación médica en su concepción como ciencia en construcción, en particular en el área de la formación permanente y continuada de los profesionales de la salud, al profundizar en el orden conceptual, metodológico y epistemológico en los procesos de desempeño profesional y superación.

The fast scientific and technological development of Ophthalmology requires a systematic updating from the theoretical and practical points of view. To such effects, a training strategy was designed for the improvement of professional performance of the primary care ophthalmologists directed to the comprehensive care of patients with retinal vascular occlusions. Empiric and theoretical level methods were used. The strategy was designed in 4 stages and the Deming cycle was implemented as methodological referent. Essential relationships were established which offer internal logical coherence to the Medical Education in its conception as science, particularly in the area of permanent and continued training of the health professionals, as there is a deepening in the conceptual, methodological and epistemological order in the processes of professional and training performance.

Cataract as a Cause of Blindness and Vision Impairment in Latin America: Progress Made and Challenges Beyond 2020.

PURPOSE: To provide an update of cataract as a cause of vision loss in Latin America and to analyze sex inequalities in cataract surgical coverage (CSC) and effective CSC (eCSC) in the region. DESIGN: Population-based systematic review with longitudinal comparisons. METHODS: The Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed databased were searched for population-based studies reporting cataract blindness, surgical coverage, and outcomes published between January 2014 and December 2019. Information on the number of surgeries performed from the 2014-2016 period was obtained from ministries of health and was used for calculation of the cataract surgical rate (CSR). Sources such as Rapid Assessment of Avoidable Blindness (RAAB) and Rapid Assessment of Cataract Surgical Services data were reanalyzed to calculate sex inequality in CSC and eCSC by subtracting the rate in women from the rate in men. RESULTS: Cataract was the cause of 29.8%-77.6% of cases of blindness in the included studies; the CSR improved in 10 countries. The CSC pinhole visual acuity of 3/60 varied from 24.1% in Peru to 97.1% in Argentina, and the median absolute gender inequality CSC pinhole visual acuity 3/60 was -0.7%. The eCSC pinhole visual acuity 3/60 varied from 14.8% in Guatemala to 92.1% in Argentina, and the median absolute gender inequality eCSC pinhole visual acuity 3/60 was -0.8%. CONCLUSIONS: Cataract remains a leading cause of blindness in Latin America. Coverage is suboptimal, and surgical results are also below target levels in many countries. Incentives for a better distribution of human resources, adequate training of ophthalmologists, and the inclusion of vision services in universal health care coverage could reduce the burden of cataract in Latin America.

Assessing Glaucoma Progression Using Machine Learning Trained on Longitudinal Visual Field and Clinical Data.

PURPOSE: Rule-based approaches to determining glaucoma progression from visual fields (VFs) alone are discordant and have tradeoffs. To detect better when glaucoma progression is occurring, we used a longitudinal data set of merged VF and clinical data to assess the performance of a convolutional long short-term memory (LSTM) neural network. DESIGN: Retrospective analysis of longitudinal clinical and VF data. PARTICIPANTS: From 2 initial datasets of 672 123 VF results from 213 254 eyes and 350 437 samples of clinical data, persons at the intersection of both datasets with 4 or more VF results and corresponding baseline clinical data (cup-to-disc ratio, central corneal thickness, and intraocular pressure) were included. After exclusion criteria-specifically the removal of VFs with high false-positive and false-negative rates and entries with missing data-were applied to ensure reliable data, 11 242 eyes remained. METHODS: Three commonly used glaucoma progression algorithms (VF index slope, mean deviation slope, and pointwise linear regression) were used to define eyes as stable or progressing. Two machine learning models, one exclusively trained on VF data and another trained on both VF and clinical data, were tested. MAIN OUTCOME MEASURES: Area under the receiver operating characteristic curve (AUC) and area under the precision-recall curve (AUPRC) calculated on a held-out test set and mean accuracies from threefold cross-validation were used to compare the performance of the machine learning models. RESULTS: The convolutional LSTM network demonstrated 91% to 93% accuracy with respect to the different conventional glaucoma progression algorithms given 4 consecutive VF results for each participant. The model that was trained on both VF and clinical data (AUC, 0.89-0.93) showed better diagnostic ability than a model exclusively trained on VF results (AUC, 0.79-0.82; P < 0.001). CONCLUSIONS: A convolutional LSTM architecture can capture local and global trends in VFs over time. It is well suited to assessing glaucoma progression because of its ability to extract spatiotemporal features that other algorithms cannot. Supplementing VF results with clinical data improves the model's ability to assess glaucoma progression and better reflects the way clinicians manage data when managing glaucoma.

Gender Compensation Gap for Ophthalmologists in the First Year of Clinical Practice.

PURPOSE: To identify the role of gender and other factors in influencing ophthalmologists' compensation. DESIGN: Cross-sectional study. PARTICIPANTS: U.S. practicing ophthalmologists. METHODS: Between January and March 2020, an anonymous survey was sent to U.S. residency program directors and practicing ophthalmologists who recently completed residency training. Respondents who completed residency ≤ 10 years ago and responded to questions about gender, fellowship training, state of practice, and salary were included. Propensity score match (PSM) analysis was performed with age, academic residency, top residency, fellowship, state median wage, practice type, ethnicity, and number of workdays. Multivariate linear regression (MLR) analysis controlled for additional factors along with the aforementioned variables. MAIN OUTCOME MEASURES: Base starting salary with bonus (SWB) received in the first year of clinical position was the main outcome measure. A multiplier of 1.2 (20%) was added to the base salary to account for bonus. RESULTS: Of 684 respondents, 384 (56% were female, 44% were male) from 68 programs were included. Female ophthalmologists received a mean initial SWB that was $33 139.80 less than that of their male colleagues (12.5%, P = 0.00). The PSM analysis showed an SWB difference of -$27 273.89 (10.3% gap, P = 0.0015). Additionally, SWB differences were calculated with the number of workdays substituted by operating room (OR) days (-$27 793.67 [10.5% gap, P = 0.0013]) and clinic days (-$23 597.57 [8.90% gap, P = 0.0064]) in separate PSM analyses. The SWB differences between genders were significant using MLR analyses, which also controlled for work, clinic, and OR days separately (-$22 261.49, $-18 604.65, and $-16 191.26, respectively; P = 0.017, P = 0.015, P = 0.002, respectively). Gender independently predicted income in all 3 analyses (P < 0.05). Although an association between gender and the attempt to negotiate was not detected, a greater portion of men subjectively reported success in negotiation (P = 0.03). CONCLUSIONS: Female ophthalmologists earn significantly less than their male colleagues in the first year of clinical practice. Salary differences persist after controlling for demographic, educational, and practice type variables with MLR and PSM analyses. These income differences may lead to a substantial loss of accumulated earnings over an individual's career.

Intense Simulation-Based Surgical Education for Manual Small-Incision Cataract Surgery: The Ophthalmic Learning and Improvement Initiative in Cataract Surgery Randomized Clinical Trial in Kenya, Tanzania, Uganda, and Zimbabwe.

Importance: Cataracts account for 40% of cases of blindness globally, with surgery the only treatment. Objective: To determine whether adding simulation-based cataract surgical training to conventional training results in improved acquisition of surgical skills among trainees. Design, Setting, and Participants: A multicenter, investigator-masked, parallel-group, randomized clinical educational-intervention trial was conducted at 5 university hospital training institutions in Kenya, Tanzania, Uganda, and Zimbabwe from October 1, 2017, to September 30, 2019, with a follow-up of 15 months. Fifty-two trainee ophthalmologists were assessed for eligibility (required no prior cataract surgery as primary surgeon); 50 were recruited and randomized. Those assessing outcomes of surgical competency were masked to group assignment. Analysis was performed on an intention-to-treat basis. Interventions: The intervention group received a 5-day simulation-based cataract surgical training course, in addition to standard surgical training. The control group received standard training only, without a placebo intervention; however, those in the control group received the intervention training after the initial 12-month follow-up period. Main Outcomes and Measures: The primary outcome measure was overall surgical competency at 3 months, which was assessed with a validated competency assessment rubric. Secondary outcomes included surgical competence at 1 year and quantity and outcomes (including visual acuity and posterior capsule rupture) of cataract surgical procedures performed during a 1-year period. Results: Among the 50 participants (26 women [52.0%]; mean [SD] age, 32.3 [4.6] years), 25 were randomized to the intervention group, and 25 were randomized to the control group, with 1 dropout. Forty-nine participants were included in the final intention-to-treat analysis. Baseline characteristics were balanced. The participants in the intervention group had higher scores at 3 months compared with the participants in the control group, after adjusting for baseline assessment rubric score. The participants in the intervention group were estimated to have scores 16.6 points (out of 40) higher (95% CI, 14.4-18.7; P < .001) at 3 months than the participants in the control group. The participants in the intervention group performed a mean of 21.5 cataract surgical procedures in the year after the training, while the participants in the control group performed a mean of 8.5 cataract surgical procedures (mean difference, 13.0; 95% CI, 3.9-22.2; P < .001). Posterior capsule rupture rates (an important complication) were 7.8% (42 of 537) for the intervention group and 26.6% (54 of 203) for the control group (difference, 18.8%; 95% CI, 12.3%-25.3%; P < .001). Conclusions and Relevance: This randomized clinical trial provides evidence that intense simulation-based cataract surgical education facilitates the rapid acquisition of surgical competence and maximizes patient safety. Trial Registration: Pan-African Clinical Trial Registry, number PACTR201803002159198.

Perceptions of Occupational Risk and Changes in Clinical Practice of United States Vitreoretinal Surgery Fellows during the COVID-19 Pandemic.

PURPOSE: To assess perceptions of occupational risk and changes to clinical practice of ophthalmology trainees in the United States during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: An anonymous, nonvalidated, cross-sectional survey was conducted online. Data were collected from April 7 through 16, 2020. PARTICIPANTS: Second-year U.S. vitreoretinal surgery fellows in two-year training programs were invited to participate. METHODS: Online survey. MAIN OUTCOME MEASURES: Survey questions assessed policies guiding COVID-19 response, exposure to severe acute respiratory syndrome coronavirus 2, changes in clinical duties, and methods to reduce occupational risk, including availability of personal protective equipment (PPE). RESULTS: Completed responses were obtained from 62 of 87 eligible recipients (71.2% response rate). Training settings included academic (58.1%), hybrid academic/private practice (35.5%), and private practice only settings (6.5%). Overall, 19.4% of respondents reported an exposure to a COVID-19-positive patient, 14.5% reported self-quarantining due to possible exposure, and 11.3% reported being tested for COVID-19. In regards to PPE, N95 masks were available in the emergency room (n = 40 [64.5%]), office (n = 35 [56.5%]), and operating room (n = 35 [56.5%]) settings. Perceived comfort level with PPE recommendations was significantly associated with availability of an N95 respirator mask in the clinic (P < 0.001), emergency room (P < 0.001), or operating room (P = 0.002) settings. Additional risk mitigation methods outside of PPE were: reduction in patient volume (n = 62 [100%]), limiting patient companions (n = 59 [95.2%]), use of a screening process (n = 59 [95.2%]), use of a slit-lamp face shield (n = 57 [91.9%]), temperature screening of all persons entering clinical space (n = 34 [54.84%]), and placement of face mask on patients (n = 33 [53.2%]). Overall, 16.1% reported additional clinical duties within the scope of ophthalmology, and 3.2% reported being re-deployed to nonophthalmology services. 98.4% of respondents, 98.4% expected a reduction in surgical case volume. No respondents reported loss of employment or reduction in pay or benefits due to COVID-19. CONCLUSIONS: Suspected or confirmed clinical exposure to COVID-19-positive patients occurred in approximately one fifth of trainee respondents. Perceived comfort level with PPE standards was significantly associated with N95 respirator mask availability. As surgical training programs grapple with the COVID-19 pandemic, analysis of trainees' concerns may inform development of mitigation strategies.

Awareness and knowledge of diabetic retinopathy and associated factors in Goa: A hospital-based cross-sectional study.

Purpose: To assess the awareness and knowledge about diabetic retinopathy (DR) and associated factors among patients visiting the tertiary health center in Goa. Methods: A cross-sectional descriptive study was conducted using a standard predesigned and pretested closed-ended structured questionnaire to assess the awareness, knowledge, attitude and practice about DR among patients visiting a tertiary health center. Results: Three hundred and fifty-eight subjects participated in the study. Only 125 (34.9% [95% CI: 30.0-40.1]) subjects were aware of DR and 122 (34.1% [95% CI: 29.2-39.2]) had adequate knowledge about DR. Awareness and knowledge of DR were significantly high among the subjects who completed college level of education (66.7%, OR = 2.78; 95% CI: 1.73-4.48, P < 0.001 and 55.9%, OR = 3.92; 95% CI: 2.41-6.38, P < 0.001) and who spoke English (52.5%, OR = 3.37; 95% CI: 2.14-5.30, P < 0.001 and 50.4%, OR = 3.26; 95% CI: 2.07-5.14, P < 0.001). Christians reported better knowledge about DR compared to other religions (48.8%, OR = 2.27; 95% CI: 1.38-3.75, P = 0.005). Negative association was noted between the knowledge of DR and presence of diabetes (29.4%, OR = 0.64; 95% CI: 0.41-0.99, P = 0.048). The practice pattern was strongly associated (OR = 7.47; 95% CI: 4.51-12.38, P < 0.001) with the knowledge of DR. Attitude was not influenced by any of the factors. Conclusion: We found that awareness and knowledge about DR were unsatisfactory; literacy contributed significantly toward it. These findings also suggest that there is an immediate need to enhance the awareness and knowledge of diabetic eye diseases in order to reduce the burden of visual impairment.

Ophthalmology residency training in India: Comparing feedback about how the training equips ophthalmologists to combat retinal diseases. READS report #6.

Purpose: To document whether the residency training in management of retinal diseases has improved in 2000s to meet the increasing demand of retina care in India. Methods: A survey, using a prevalidated questionnaire, was conducted by Academic and Research Committee (ARC) of the All India Ophthalmological Society (AIOS) in 2014-2016 among ophthalmologists to document teaching of retina-related clinical and surgical skills in the postgraduate residency program. Results: The 144-item questionnaire was mailed to 4512 practicing ophthalmologists with residency training in two different periods, between 1967 and 2000 (group 1; 20th-century trained) and between 2003 and 2012 (group 2; 21st-century trained). Response was received from 320 (19.1%) of group 1 ophthalmologists and 531 (18.7%) of group 2 ophthalmologists. The average age was 49.2 ± 8.7 and 32.6 ± 4 years, respectively. Group 2 residents had received superior training in indirect ophthalmoscopy, slit lamp biomicroscopy using + 78 and + 90D lens, optical coherence tomography, fundus photography, and fluorescein angiography (all P < 0.001), but there was large variation between the training institutions. The residents were not taught vitreous and retinal detachment surgeries in either period of training. Conclusion: Teaching of retina-related clinical skills have improved in Indian residency program, but there are variations across programs. This information might help redesign the ophthalmology residency programs to meet the demands of comprehensive eye care and universal health coverage of increasing retinal diseases in India.