Cataract surgical training in Europe: European Board of Ophthalmology survey.

PURPOSE: To survey recently graduated European ophthalmologists concerning cataract surgery (CS) training opportunities. SETTING: Countries affiliated to the European Board of Ophthalmology (EBO). DESIGN: Cross-sectional study of anonymous survey results. METHODS: A 23-question online survey was emailed to candidates who sat the EBO Diploma Examination as residents between 2018 and 2022. RESULTS: 821 ophthalmologists from 30 countries completed the survey. The mean residency duration was 4.73 (SD 0.9) years. The mean reported number of entire CS procedures performed was 80.7 (SD 100.6) at the end of residency, but more than 25% of respondents (n = 210) had received no live CS training during their residency. The self-confidence (scale, 1 to 10) to perform a simple case or challenging case, manage posterior capsular rupture, and realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and self-reported confidence to perform CS between European trainees. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (P < .05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (P < .001). The importance of fellowships to complete surgical education was rated 7.7 out of 10. CONCLUSIONS: CS training across European countries lacks harmony. Female ophthalmology trainees continue, as in other specialties, to experience apparent gender bias. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and promote post-residency fellowship training programs.

Myopia management algorithm. Annexe to the article titled Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute.

Myopia is becoming increasingly common in young generations all over the world, and it is predicted to become the most common cause of blindness and visual impairment in later life in the near future. Because myopia can cause serious complications and vision loss, it is critical to create and prescribe effective myopia treatment solutions that can help prevent or delay the onset and progression of myopia. The scientific understanding of myopia's causes, genetic background, environmental conditions, and various management techniques, including therapies to prevent or postpone its development and slow its progression, is rapidly expanding. However, some significant information gaps exist on this subject, making it difficult to develop an effective intervention plan. As with the creation of this present algorithm, a compromise is to work on best practices and reach consensus among a wide number of specialists. The quick rise in information regarding myopia management may be difficult for the busy eye care provider, but it necessitates a continuing need to evaluate new research and implement it into daily practice. To assist eye care providers in developing these strategies, an algorithm has been proposed that covers all aspects of myopia mitigation and management. The algorithm aims to provide practical assistance in choosing and developing an effective myopia management strategy tailored to the individual child. It incorporates the latest research findings and covers a wide range of modalities, from primary, secondary, and tertiary myopia prevention to interventions that reduce the progression of myopia.

The impact of the pandemic highlights the urgent need for myopia guidelines: The clinicians' role.

Myopia is already one of the leading causes of permanent vision impairment, including blindness, and the COVID-19 pandemic has exacerbated the global myopia-related burden among children owing to home confinement, increased screen time (e-learning), and decreased outside activities. To reverse the rising trend of myopia and myopia-related blindness, collaborative efforts are required. There is a wealth of evidence-based medicine (EBM) data on the epidemiology of myopia and effective interventions, but very little has been published on the clinicians' roles and responsibilities. However, this aspect is critical because preventing the onset and progression of myopia necessitates extensive health promotion and advocacy efforts among decision-makers. Only broad medical expert collaboration can bring about the necessary changes in children's lifestyle and education. This article discusses clinicians' critical roles in preventing the onset and progression of myopia.

The Postnatal Growth and Retinopathy of Prematurity Model: A Multi-institutional Validation Study.

PURPOSE: The G-ROP model was proposed to improve the retinopathy of prematurity (ROP) screening efficiency. It is based on gestational age, birth weight and postnatal weight gain. The current study aimed to validate the G-ROP model's ability to predict ROP in cohorts of premature infants from Egypt and the United Kingdom (UK). METHODS: We retrospectively reviewed the records of preterm infants born between 1st of January and 30th of June 2018 with a known outcome for ROP screening and regular weight measurements until day 39 after birth. We applied the G-ROP model to the study group and calculated the sensitivity of the model for detecting Early Treatment of ROP (ETROP) study type 1 ROP and for any ROP and calculated the reduction of the number of infants requiring ROP screening by the model application. RESULTS: We applied the G-ROP model on 605 infants (504 from Egypt and 101 from the UK). The model successfully predicted all type 1 ROP cases (100% sensitivity) in both cohorts (95% confidence interval [CI], 91.1-100% in the Egyptian cohort and 65.5-100% in the UK cohort). The model reduced the number of infants requiring screening by 14.1% in the Egyptian cohort and 21.8% in the UK cohort. CONCLUSIONS: The G-ROP model was successfully validated for detecting type 1 ROP and in both cohorts from Egypt and the UK.

Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute.

The prevalence of myopia is increasing extensively worldwide. The number of people with myopia in 2020 is predicted to be 2.6 billion globally, which is expected to rise up to 4.9 billion by 2050, unless preventive actions and interventions are taken. The number of individuals with high myopia is also increasing substantially and pathological myopia is predicted to become the most common cause of irreversible vision impairment and blindness worldwide and also in Europe. These prevalence estimates indicate the importance of reducing the burden of myopia by means of myopia control interventions to prevent myopia onset and to slow down myopia progression. Due to the urgency of the situation, the European Society of Ophthalmology decided to publish this update of the current information and guidance on management of myopia. The pathogenesis and genetics of myopia are also summarized and epidemiology, risk factors, preventive and treatment options are discussed in details.

Procedural aspects of the organization of the comprehensive European Board of Ophthalmology Diploma examination.

The comprehensive European Board of Ophthalmology Diploma (EBOD) examination is one of 38 European medical specialty examinations. This review aims at disclosing the specific procedures and content of the EBOD examination. It is a descriptive study summarizing the present organization of the EBOD examination. It is the 3rd largest European postgraduate medical assessment after anaesthesiology and cardiology. The master language is English for the Part 1 written test (knowledge test with 52 modified type X multiple-choice questions) (in the past the written test was also available in French and German). Ophthalmology training of minimum 4 years in a full or associated European Union of Medical Specialists (UEMS) member state is a prerequisite. Problem-solving skills are tested in the Part 2 oral assessment, which is a viva of 4 subjects conducted in English with support for native language whenever feasible. The comprehensive EBOD examination is one of the leading examinations organized by UEMS European Boards or Specialist Sections from the point of number of examinees, item banking, and item contents.

Introduction of subspecialty examinations by the European Board of Ophthalmology (EBO) in close collaboration with European Subspecialty Ophthalmological Societies: FEBO-SA.

The European Board of Ophthalmology (EBO) aims to establish common European standards in ophthalmology. The comprehensive EBO Diploma (EBOD) examination has been officially used since 1995 by an increasing number of European countries to assess the level of education in ophthalmology of their residents at the end of their training. The current comprehensive EBOD examination ensures a minimum standard of knowledge. We present an update on the EBO plans to establish a subspecialty advanced EBOD (AdEBOD) examination in order to award ophthalmologists who complete subspecialty training with formal recognition of their expertise. The purpose, structure and process of the AdEBOD examination are presented.

Isolated extraocular muscle abscess presenting 40 years after squint surgery.

A 57-year-old man presented with an abscess localised to the lateral rectus region. He was treated as a case of orbital cellulitis because of the presence of soft tissue swelling with a localised abscess discharging through the conjunctiva with associated reduction of visual acuity and restriction of ocular movements laterally. No specific risk factors were identified but an ultrasound scan picked up a hyperechoic signal suggestive of a foreign body within the abscess. Surgical exploration did not identify a foreign body but fibrotic changes between the globe and the lateral rectus muscle were found which was suggestive of previous squint surgery. This was confirmed by the patient later on specific questioning. Periorbital infection is a rare occurrence after squint surgery and reported cases are mainly within a week after surgery. Orbital abscess probably related to an old suture granuloma 40 years after surgery has not been documented before.

History and future of the European Board of Ophthalmology Diploma examination.

PURPOSE: The European Board of Ophthalmology Diploma (EBOD) examination has evolved over the last few years, especially with the introduction of negative marking (-0.5 points) for incorrect or blank answers (0 points for don't know option), which aimed to improve the quality and reliability of the examination. METHODS: In 2010, negative marking at the written part of the EBOD examination has been introduced in an attempt to improve not only the reliability of the examination as entity but also the statistical performance parameters of the individual questions. As lower pass rates and discrimination of female candidates are feared by the general public when negative marking is concerned, these parameters have been explicitly investigated. RESULTS: Introduction of negative marking has not only lead to improved reliability of the EBOD examination (increased Cronbach's alpha value: ≤0.80 without and ≥0.90 with negative marking), but also to improved statistical performance parameters of the individual questions. The pass rate of the EBOD examination has proven to remain at the same high level as without negative marking (around 90%). Furthermore, although female candidates do seem to have different answering strategies (p < 0.01, use of don't know option), no statistically significant difference has been found between total scores of male and female candidates (p > 0.05). CONCLUSION: Introduction of negative marking at the written EBOD examination has proven to be beneficial, not only for the organizers (improvement of the statistical performance of the examination and its questions), but also for candidates (better discrimination with borderline candidates). These results have been obtained without evidence of lower pass rates or discrimination of female candidates.

Evaluation of adding item-response theory analysis for evaluation of the European Board of Ophthalmology Diploma examination.

PURPOSE: To investigate whether introduction of item-response theory (IRT) analysis, in parallel to the 'traditional' statistical analysis methods available for performance evaluation of multiple T/F items as used in the European Board of Ophthalmology Diploma (EBOD) examination, has proved beneficial, and secondly, to study whether the overall assessment performance of the current written part of EBOD is sufficiently high (KR-20≥ 0.90) to be kept as examination format in future EBOD editions. METHODS: 'Traditional' analysis methods for individual MCQ item performance comprise P-statistics, Rit-statistics and item discrimination, while overall reliability is evaluated through KR-20 for multiple T/F items. The additional set of statistical analysis methods for the evaluation of EBOD comprises mainly IRT analysis. These analysis techniques are used to monitor whether the introduction of negative marking for incorrect answers (since EBOD 2010) has a positive influence on the statistical performance of EBOD as a whole and its individual test items in particular. RESULTS: Item-response theory analysis demonstrated that item performance parameters should not be evaluated individually, but should be related to one another. Before the introduction of negative marking, the overall EBOD reliability (KR-20) was good though with room for improvement (EBOD 2008: 0.81; EBOD 2009: 0.78). After the introduction of negative marking, the overall reliability of EBOD improved significantly (EBOD 2010: 0.92; EBOD 2011:0.91; EBOD 2012: 0.91). CONCLUSION: Although many statistical performance parameters are available to evaluate individual items, our study demonstrates that the overall reliability assessment remains the only crucial parameter to be evaluated allowing comparison. While individual item performance analysis is worthwhile to undertake as secondary analysis, drawing final conclusions seems to be more difficult. Performance parameters need to be related, as shown by IRT analysis. Therefore, IRT analysis has proved beneficial for the statistical analysis of EBOD. Introduction of negative marking has led to a significant increase in the reliability (KR-20 > 0.90), indicating that the current examination format can be kept for future EBOD examinations.

Five-decade profile of women in leadership positions at ophthalmic publications.

OBJECTIVE: To evaluate the balance between the sexes of published ophthalmic material at the editorial, reviewer, and author levels. DESIGN: Cross-sectional study of 3 journals, American Journal of Ophthalmology, Archives of Ophthalmology, and Ophthalmology, for 1969, 1979, 1989, 1999, and 2009. The data were compared with ophthalmologist-in-training and physician profile in major contributing states from North America and Europe during the same period. RESULTS: Of the 3 major ophthalmology journals, none had a female editor-in-chief. For all journals, the proportion of editorial board members who were women increased from 3.3% in 1969 to 18.8% in 2009. For all journals and all years, women composed a higher proportion of first authors (29.2% in 2009) compared with senior authors (22.9% in 2009), reviewers (18.9% in 2009), or assistant editors (12.5% in 2009). There was an abrupt shift toward women after 1989 in first authorship in Ophthalmology (1969, 4.6%; 1979, 5.4%; 1989, 12.3%; and 1999, 20.2%), Archives of Ophthalmology (1969, 6.6%; 1979, 5.1%; 1989, 15.6%; and 1999, 28.6%), and American Journal of Ophthalmology (1969, 5.6%; 1979, 4.2%; 1989, 9.2%; and 1999, 23.9%). There was also an abrupt increase in female senior authorship for American Journal of Ophthalmology after 1989 (1979, 8.5%; 1989, 8.1%; and 1999, 18.3%). The increase in female first authorship during the 5 decades was parallel with the increase in US female physicians. CONCLUSIONS: Women ophthalmologists are authoring publications in increasing numbers that match their prevalence in the academic and overall workforce. However, all editors are men. This discrepancy relates to the relatively younger generation of female ophthalmologists or selection bias, a subject that requires further investigation.

Soft lens matter recurrence after congenital cataract surgery.

UNLABELLED: We report a case of soft lens matter recurrence 17 years after the original congenital cataract was removed. To our knowledge, this is the longest interval for soft lens matter to recur. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.