[Career prospects for ophthalmologists under 49 years old : A survey in Germany from 2022]. / Berufliche Zukunftsperspektive von Augenärzten unter 49 Jahren : Eine Umfrage in Deutschland aus dem Jahr 2022.

OBJECTIVE: The need for care in ophthalmology is constantly increasing due to demographic changes. The study analyzed the current professional situation and future prospects of ophthalmologists under 49 years old. METHODS: The survey of members of the German Association of Ophthalmologists (Berufsverband der Augenärzte Deutschlands) and the German Ophthalmologic Society (Deutsche Ophthalmologische Gesellschaft) was conducted in 2022. All members under the age of 49 years received an online questionnaire on the current professional situation as well as future perspectives (desired working hours, form of organization). The results of the survey were additionally compared with the 2016 survey of the German Association of Ophthalmologists. A similar questionnaire was used at that time. RESULTS: A total of 1014 people participated in the survey (62.7% women, mean age 39.3 ± 8 years, 75.6% specialists). The response rate to the survey was 25%. Specialist practice from 0 to 5 years showed a higher number of employed ophthalmologists (21% self-employed vs. 32% employed); over time the number of self-employed ophthalmologists increased (6-10 years: 40%, > 10 years: 59.3%). Overall, 46% of women were employed in a practice compared with 33% of men. Of the self-employed specialists, 95.9% said they planned to work in the same type of employment in 10 years as currently. Regarding ophthalmologists' career future, the other employment types showed a desire to move to independent practice. Compared to the 2016 survey, gender differences related to the current type of employment were evident. The number of self-employed women decreased from 43% to 26% and self-employed men decreased from 63% to 39%. The number of ophthalmologists in ambulatory healthcare centers was doubled compared to 2016. Ophthalmologists reported similar future perspectives at both survey times. CONCLUSION: The results of the survey of ophthalmologists under 49 years in Germany showed similar perceptions as in 2016. It became clear that the desire to be self-employed in 10 years is very high; however, ophthalmologists expected large practices or medical care centers to prevail in the market. The number of self-employed doctors is decreasing and the desire for self-employment is difficult to realize.

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis.

Uveitis in juvenile idiopathic arthritis (JIA) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first-choice therapy, and immunosuppression is commonly used. However, treatment has not been standardized. Representatives from the German Ophthalmological Society, Society for Childhood and Adolescent Rheumatology, and the German Society for Rheumatology reached consensus on a standardized treatment strategy according to disease severity in the individual patient. The recommendations were based on a systematic literature analysis in MEDLINE and consensus expert meetings. Evidence and recommendations were graded, and an algorithm for anti-inflammatory treatment and final statements confirmed in a Delphi method. An interdisciplinary, evidence-based treatment guideline for JIA uveitis is presented.

[The most serious incident-Experiences of aggression and violence in ophthalmology]. / Der schwerwiegendste Vorfall ­ Erfahrungen von Aggressionen und Gewalt in der Augenheilkunde.

BACKGROUND: Experiences of aggression/violence influence job satisfaction and can have a long-term psychological and physical impact on employees. In the fall of 2018, the Professional Association of Ophthalmologists (BVA) and the German Ophthalmological Society (DOG) conducted a survey on experiences of aggression and violence. The first results were published in 2020. In the survey it was also possible to describe the most serious incident to date using free text fields, among others. METHOD: All 9411 members of the DOG and BVA were given the opportunity to complete a questionnaire online in 2018 regarding aggression and violence in ophthalmology. RESULTS: Overall, 253 of 1508 (16.8%) ophthalmologists participating in the survey reported their most serious incident, 46.8% of which were classified as moderate and 34.3% were related to verbal violence such as insults and threats. The most serious incident was experienced by 171 (67.6%) physicians in a practice setting, 71% were specialists at the time of the incident and 74.3% of the incidents occurred during regular working hours. The main causes were intercultural conflicts, long waiting times, problems with the allocation of appointments, excessive expectations, differences in treatment and basic aggressiveness. The offenders were male in 86.3% of cases, 15.8% of the incidents were reported to the police and 21 (8.3%) physicians issued a practice reprimand or house ban. DISCUSSION: The description of the most serious incidents illustrates situations that are sometimes hard to imagine and also which incidents were considered serious. There are large subjective variations in the assessment of the incidents. Protective measures in practices and clinics are essential.

[Assessment of subjective risk of infection and willingness to vaccinate against SARS-CoV-2 among German ophthalmologists : Results of a survey by DOG and BVA]. / Einschätzung des subjektiven Infektionsrisikos und Impfbereitschaft gegen SARS-CoV-2 unter deutschen Augenärzten : Ergebnisse einer Umfrage von DOG und BVA.

BACKGROUND AND OBJECTIVE: After approval of the first COVID-19 vaccines in Germany, vaccination prioritization and vaccination preparedness are central topics in the discussion on strategies to end the pandemic. How ophthalmologists evaluate their risk of infection and whether they are willing to be vaccinated has not been investigated so far. The aim of this project was to assess the subjective rating of the risk of infection and the willingness to be vaccinated among German ophthalmologists. METHODS: Data were collected by an anonymous online survey conducted by the Professional Association of Ophthalmologists in Germany (BVA) and the German Ophthalmological Society (DOG) under the auspices of the University Eye Hospital Düsseldorf. The questionnaire was open for participation from 22 January to 12 February 2021. The survey was addressed to all colleagues in ophthalmology. RESULTS: A total of 1162 completed questionnaires were analyzed. On average, survey respondents rated their risk of infection as 7.5 ± 1.9 (scale of 1-10; 1 = very low risk, 10 = very high risk). Of the respondents 971 (83.6%) rated their risk of infection as higher compared to other disciplines and 92.9% (n = 1079) indicated they would be willing to be vaccinated. CONCLUSION: The ophthalmologists interviewed consider their professional group to be exposed to an above-average risk of SARS-COV­2 infection compared to other disciplines. They frequently criticized the prioritization ranking of the German Ministry of Health (BMG), which deviated from the suggestions of the Standing Vaccination Committee of Germany (STIKO). The willingness to be vaccinated was very high among the surveyed German ophthalmologists.

[Intravitreal drug therapy for retinal vein occlusion--pathophysiological mechanisms and routinely used drugs]. / Intravitreale Medikamenteneingabe bei retinalem Venenverschluss--pathophysiologische Mechanismen und angewandte Substanzen.

The novel therapeutic principle of intravitreal drug therapy for retinal vein occlusion has become an integrated constituent of clinical practice over the last years. The two substance classes that have been evaluated in large randomised clinical trials so far are corticosteroids and inhibitors of vascular endothelial growth factor (VEGF). The reported treatment success of these intravitreally administered substances has lead not only to a paradigm shift in clinical care but has also advanced our understanding of the underlying pathophysiological principles of retinal vein occlusions. In this review the different substances are discussed, their mechanisms of action are analysed and the results of the large clinical trials available to date are critically evaluated. Furthermore, an approach to integrate these novel treatment options into the existing treatment regimes for retinal vein occlusions is suggested.

[Experiences of aggression and violence against ophthalmologists]. / Erfahrungen von Aggression und Gewalt gegen Augenärztinnen und Augenärzte.

BACKGROUND: The media have reported an increased willingness of patients and relatives to use violence against medical personnel. So far a few studies have been carried out on this topic and the data situation is correspondingly weak. Ophthalmologists in particular have close contact with patients at the slit lamp and are often alone with patients. METHODS: A questionnaire was developed based on the perception of prevalence of aggression scale (POPAS) questionnaire and the survey on aggression and violence among general practitioners. In autumn 2018, all members of the German Ophthalmological Society (DOG) and the Professional Association of Ophthalmologists (BVA) received an invitation by e­mail to complete the questionnaire online. RESULTS: Of the 9411 ophthalmologists contacted a total of 1508 (age 49 ± 12 years) took part in the survey (16%). Of the respondents 806 (53.7%) were female and 1139 (75.5%) participants worked in practices. A total of 1264 (83.3%) ophthalmologists had experienced aggression/violence in their work, 986 (65%) respondents had already experienced verbal assaults without threats, 363 (24.1%) doctors reported experiences with threats of physical violence and 30 (2%) participants had received medical treatment for severe physical violence. Sexual intimidation/harassment was affirmed by 322 (21.4%) of respondents, of whom 243 (75.5%) were female and 533 (47.9%) doctors felt that aggressive/violent behavior had increased in the last 5 years. CONCLUSION: The high number of participants indicates the high relevance of the topic. The survey produced astonishing results, which should lead to further discussion and action to improve the safety of employees.

Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis.

BACKGROUND: Uveitis in juvenile idiopathic arthritis (JIAU) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first line therapy, and disease modifying anti-rheumatic drugs (DMARDs) are commonly used. However, treatment has not been standardized. METHODS: Interdisciplinary guideline were developed with representatives from the German Ophthalmological Society, Society for Paediatric Rheumatology, Professional Association of Ophthalmologists, German Society for Rheumatology, parents' group, moderated by the Association of the Scientific Medical Societies in Germany. A systematic literature analysis in MEDLINE was performed, evidence and recommendations were graded, an algorithm for anti-inflammatory treatment and final statements were discussed in a consensus meeting (Nominal Group Technique), a preliminary draft was fine-tuned and discussed thereafter by all participants (Delphi procedure). RESULTS: Consensus was reached on recommendations, including a standardized treatment strategy according to uveitis severity in the individual patient. Thus, methotrexate shall be introduced for uveitis not responding to low-dose (≤ 2 applications/day) topical corticosteroids, and a TNFalpha antibody (preferably adalimumab) used, if uveitis inactivity is not achieved. In very severe active uveitis with uveitis-related deterioration of vision, systemic corticosteroids should be considered for bridging until DMARDs take effect. If TNFalpha antibodies fail to take effect or lose effect, another biological should be selected (tocilizumab, abatacept or rituximab). De-escalation of DMARDs should be preceded by a period of  ≥ 2 years of uveitis inactivity. CONCLUSIONS: An interdisciplinary, evidence-based treatment guideline for JIAU is presented.

[Who visits an ophthalmologist and how often? Results of the German nationwide adult health survey (DEGS1)]. / Wer geht wie oft zum Augenarzt in Deutschland? Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

BACKGROUND: The prevalence of eye diseases increases in the second half of life, especially cataract, glaucoma and age-related macular degeneration. In this study we examined the influencing factors for visiting an ophthalmologist in the last 12 months. METHODS: Visits to an ophthalmologist's practice in the last 12 months and the frequency were surveyed in the German nationwide adult health survey wave 1 (DEGS1) study (baseline examination from 2008 to 2011, N = 7987, 52.6% women, age 18-79 years). Data on utilization were processed by taking the complex study design into consideration. Multivariable logistic regression analysis was used to determine associated factors including age, sex, socioeconomic status, place of residence, type of health insurance (e.g. statutory or private) and diabetes. RESULTS: Between the ages of 18 and 79 years, 29.3% of survey participants in Germany visited an ophthalmologist in the last year, while after the age of 60 years this was only 50.4%. Multivariable logistic regression analysis showed an association with female sex (odds ratio OR = 1.51, p < 0.001), older age, type of health insurance (private vs. statutory: OR = 0.77, p = 0.006) and diabetes (OR = 3.84, p < 0.001), but no association with socioeconomic status (p = 0.29) or place of residence (p = 0.06). CONCLUSION: Approximately one third of the German population visit an ophthalmologist at least once a year. Especially diabetics showed a high utilization of ophthalmological consultations, which could be based on the interdisciplinary guidelines for early detection of diabetic eye complications.

[Prevalence of diabetic retinopathy. Check-up program of a public health insurance company in Germany 2002-2004]. / Prävalenz der diabetischen Retinopathie. Studie bei Versicherten der Deutschen Betriebskrankenkasse 2002-2004.

OBJECTIVES: Population based studies have reported a prevalence of diabetic retinopathy (DR) at the time of diagnosis in up to 30% of the patients. In the context of a general diabetes check-up program (so called "Diabetes-TUV"), the prevalence of diabetic retinopathy in Germany was examined in all diabetes patients insured in a public health insurance company. METHODS: Patients were screened in the offices of 181 ophthalmologists according to a standardized protocol formulated by Prof. Kroll, Marburg. A total of 6,500 sheets were analysed out of which 14.5% were multiply documented. The latest protocols of 5,596 patients were evaluated; the mean age was 64.7 years with an average duration of diabetes of 10.2 years. RESULTS: Some 86.3% of the eyes examined had no DR, in 3.1% no evaluation was possible. Of the patients checked, 10.6% had DR. Mild/moderate DR was reported in 8.3%, severe non-proliferative DR in 1.7% and proliferative DR in 0.5%. Macular edema was reported in 0.85% of cases, vitreous hemorrhage in 0.2%. There was 0.1% iris neovascularisation and 0.1% retinal detachment. Visual impairment due to cataract or secondary cataract was found in 25.2% of patients with an 8.3% pseudophakia rate. CONCLUSION: Documentation of the eye examination in the diabetes check-up program was good. The 10.6% prevalence of DR in Germany, even after long standing diabetes, seems to be lower than in earlier population based studies in the US or UK. The data reported here could be an indication of better diabetes care in Germany. However, not all patients were examined with dilated pupils, and in the case of severe changes, the ophthalmologist might have decided not to fill in the report form and to have chosen another form of communication.

[National guidelines for treatment of diabetic retinopathy : Second edition of the national guidelines for treatment of diabetic retinopathy]. / Nationale Versorgungsleitlinie (NVL) Diabetische Retinopathie : 2. Auflage der NVL zur Therapie der diabetischen Retinopathie.

The updated German clinical practice guidelines (second edition) describe the consensus recommendations for prevention and treatment of retinal complications secondary to diabetes. According to the updated numbers on epidemiology a further increase of persons affected is expected. The prevalence of diabetic retinopathy is estimated to be 9-16 % in type 2 diabetes and 24-27 % in type 1 diabetes. A prolongation of the screening interval from 1 to 2 years is recommended for those patients with a lower risk of progression, when retinopathy has not already occurred and no increased systemic risk factors are present. Standardized documentation forms are the foundation for improved communication between the disciplines. If diabetic retinopathy is present, control examinations follow the stipulations of the ophthalmologist. The guidelines define scenarios when the use of optical coherence tomography (OCT) is necessary, e. g. diagnosis and follow-up of macular edema. Besides focal and panretinal laser therapy, the efficacy and risks of intravitreal operative pharmacotherapy are discussed. Focal laser coagulation is recommended for therapy of macular edema without foveal involvement and for macular edema with foveal involvement patients should be informed about the effective alternative forms of treatment. Panretinal laser coagulation is recommended for first line treatment of proliferative diabetic retinopathy and is optional for severe non-proliferative retinopathy.

Sugar-linked dithiocarbamates as modulators of metabolic and genotoxic properties of N-nitroso compounds.

A series of putative anticarcinogenic and antimutagenic compounds was synthesized on the basis of tetraethylthiuram disulfide (disulfiram) and its metabolite, diethyldithiocarbamate (DDTC). Diallyldithiocarbamate was synthesized in order to combine the anticarcinogenic properties of diallyl sulfide, a known inhibitor of chemical carcinogenesis from Allium species, and those of DDTC. Several sugar-linked dithiocarbamates (SDTCs) were prepared using glucose, cellobiose, and lactose as glycosyl donors and DDTC and diallyldithiocarbamate as acceptors. All the S--glycoside bonds of SDTCs were very stable under physiological conditions in vitro. At low nitrosamine concentrations, glucose-DDTC inhibited microsomal nitrosamine dealkylases in vitro. In vivo these enzymes were also inhibited 4 h after i.p. administration of glucose-DDTC or lactose-DDTC to rats (1.7 mmol/kg); after 24 h, the values had returned to control levels. Glucose-DDTC induced the activity of glutathione-related enzymes. Concomitant treatment of rats with glucose-DDTC and N-nitrosodiethylamine (NDEA) led to a depression of the oxidative metabolism of [14C]NDEA to 14CO2 but increased the elimination of unchanged [14C]NDEA in the urine. Furthermore, glucose-DDTC totally inhibited the formation of DNA single-strand breaks induced by NDEA. All these effects may contribute to possible antimutagenic and anticarcinogenic actions of the dithiocarbamates investigated.

Quantification of cystoid changes in diabetic maculopathy.

PURPOSE: In patients with diabetic macular edema and cysts, quantification of the extent of the cystoid formation has been difficult. This study was performed to introduce reliable measurements of cysts, the quantification of the extent, and its relation to visual acuity. METHODS: Fluorescein angiography generated with a scanning laser ophthalmoscope provided detailed recognition not only of the foveal microvasculature, but also of well-demarcated cystoid formations in the early phases. The sampling area included the central 2.5 degrees of the fovea. Using digital image analysis, two independent observers estimated the area covered by cysts, the number of cysts, and the foveal avascular zone (FAZ). RESULTS: Twenty-three subjects with diabetes and macular cysts were enrolled in the current study. The mean area of the cysts was 0.315 +/- 0.241 mm2 (0.05 mm2 to 0.9 mm2), and the number of cysts ranged from 1 to 7. Both parameters, area of cysts (r2 = 0.61), and number of cysts (r2 = 0.48) showed a significant correlation with visual acuity (P < 0.01), whereas FAZ (0.08 to 0.58 mm2) showed no significant correlation with visual acuity. CONCLUSIONS: Fluorescein angiography allows a reproducible quantification of the extent of macular cysts. The relation of visual acuity to the number of cysts and to the area covered by the cystoid formation is highly significant. Thus, both these measures can provide an objective criterion for the estimation of visual prognosis and an outcome for evaluation therapy techniques.

Carcinogenicity of di(N-nitroso)-perhydropyrimidine (DNPP) after intraperitoneal application to rats.

Male Sprague-Dawley rats received 30 mg/kg body wt. (group I) or 15 mg/kg (group II) di(N-nitroso)-perhydropyrimidine (DNPP) by the intraperitoneal route once a week for life. The DNPP treatment significantly reduced the life expectancy in both groups. DNPP induced tumors of the esophagus (27% incidence in group I, 33% in group II) and possibly also of the liver (4% incidence in group I, 8% in group II).

Effects of disulfiram on mixed function oxidase system and trace element concentration in the liver of rats.

Disulfiram (DSF), an inhibitor of chemically induced carcinogenesis, and its metabolite diethyldithiocarbamate (DDTC) have been investigated for their influence on trace element distribution and on certain enzymes of the drug metabolizing system in the livers of phenobarbital (PB) treated rats. Both substances diminished the PB induced enzyme response in liver microsomes, DDTC being more effective (-85%) than DSF (-60%). The copper, cobalt and zinc content of the livers of DSF treated animals were increased by factors of 6, 3 and 1.5 respectively as compared to controls, while DDTC treatment had no influence on liver trace element content. A correlation between enzyme inhibition and enhanced trace element uptake of the liver after DSF administration could not be observed. The change of trace element transport into the liver during DSF treatment is discussed.