Stress and cataract surgery: A nationwide study evaluating surgeon burnout.

BACKGROUND: We aimed to evaluate the nationwide prevalence of stress induced burnout among cataract surgeons. We believe that knowledge of these factors can help formulate a solution to this underreported problem. METHODS: A three-part nationwide cross-sectional survey was disseminated with via the Royal College of Ophthalmologists (RCOphth) in the United Kingdom(UK). All consultants, trainees and specialty doctors and associate specialists(SAS) were invited to participate. We evaluated burnout using the Maslach Burnout Inventory (MBI). Logistic regression modelling was completed to look at factors linked to high level burnout in certain domains. RESULTS: A total of 406 respondents completed our survey. Prevalence of cataract surgery-related high burnout was estimated at 3.45% (Section A and/or B) and 40% within Personal Accomplishment (PA)(Section C of the MBI). Multiple factors were associated with increased burnout within PA: Increasing age: 61+ OR: 2.99 (1.02-8.78, p = 0.05), Number of cataract operations completed: >3000 OR 2.98 (1.03-8.64, p = 0.04), Lists per week: 2: OR 2.99 (1.38-6.47, p < 0.01), 2.5: OR 8.95 (2.58-31.02, p < 0.01), 3 or more: OR 2.64 (1.07-6.54, p = 0.04). Sleeping 8 h or more was found to be protective OR 0.52 (0.28-0.96, p = 0.04). 17% of respondents indicated they would be willing to give up cataract surgery if given the opportunity. CONCLUSION: The prevalence of stress induced burnout by cataract surgery appears to be present in a minority of surgeons. There appears to be a significant reduction in the feeling of personal achievement within the profession. A large proportion of this cohort appears to be willing to give up surgical responsibilities.

Diagnostic dilemma of ocular lymphoma.

We report a very unusual presentation of primary intraocular lymphoma masquerading as anterior uveitis with atypical symptoms. A 68-year-old man, initially presented with a 4-day history of painless, left blurred vision. Examination revealed 2 or more anterior chamber cells, mutton-fat keratic precipitates and posterior synechiae. Treatment was initiated, the eye settled, and the patient was discharged. He re-presented 7 months later with hypopyon, a hazy cornea, fibrin deposits and a narrowed anterior chamber angle. Over the coming weeks, it became apparent that the temporal iris was thickened, involving the angle, and his intraocular pressure increased despite topical dorzolamide. Following advice from a tertiary centre and referral to a regional ocular oncology centre, a transscleral biopsy was performed and suggested a ciliary body melanoma. Enucleation was advised and performed, with histological examination revealing features consistent with an ocular diffuse large B-cell lymphoma not involving the optic nerve, sclera or cornea. This is the first ever published report of a case of ocular lymphoma masquerading in this way.

Assessing patient acceptance of laser pretreatment to reduce injection burden in diabetic macular edema: a large scale postal survey.

OBJECTIVE: To canvass views about whether argon laser pretreatment to ischemic areas of retina would be acceptable if it resulted in a reduced burden of intravitreal injections. METHOD: A postal survey was mailed to all 813 patients under the care of the diabetic eye clinic at Singleton Hospital with 10 questions, explanatory information, and a stamp-addressed envelope available for returning completed questionnaires. RESULTS: Patients were strongly supportive (9.14 out of 10) of the idea of undergoing laser pretreatment if it meant less injections were needed for diabetic macular edema. CONCLUSION: This is the first time any survey has analyzed patient attitude to laser pretreatment and showed that patients were strongly in favour if it was found to reduce the need for intravitreal injections.

Assessing patient acceptance of virtual clinics for diabetic retinopathy: a large scale postal survey.

OBJECTIVE: To explore the views of patients with diabetic retinopathy and maculopathy on their acceptance of virtual clinic review in place of face-to-face clinic appointments. METHODS: A postal survey was mailed to all 813 patients under the care of the diabetic eye clinic at Singleton Hospital with 7 questions, explanatory information, and a stamped, addressed envelope available for returning completed questionnaires. RESULTS: Four hundred and ninety-eight questionnaires were returned indicating that 86.1% were supportive of the idea of virtual clinics, although only 56.9% were prepared for every visit to be virtual. Of respondents, 6.6% not happy to attend any virtual clinic. CONCLUSION: This is by far the largest survey of patients' attitudes regarding attending virtual clinics and confirms that the vast majority are supportive of this mode of health care delivery.

Retinal artery vasculitis secondary to administration of influenza vaccine.

There are many differential diagnoses in investigating patients who present with retinal vasculitis, and the laboratory investigations used to investigate this have low-to-moderate sensitivity and/or specificity. Diagnoses include conditions such as tuberculosis or sarcoidosis, which may require long courses of antibiotics or immunosuppression. Influenza vaccination has been recognised as a cause of vasculitis for decades, although a purely ocular presentation is rare. We present a case of a 78-year-old Caucasian woman presenting with a single vessel arterial vasculitis of the right eye 8 weeks following influenza vaccination at her local general practitioner practice. We encourage ophthalmologists, rheumatologists and uveitis specialists to consider influenza vaccine as a cause of ocular vasculitis if the vaccine has been recently administered.

Factors affecting visual acuity after one year of follow up after repeated intravitreal ranibizumab for macular degeneration.

AIM: Providing intravitreal ranibizumab therapy for neovascular age related macular degeneration (nARMD) is a source of increasing strain for many UK eye departments. Whilst most units attempt to adhere to the product licence of following up patients at four weekly intervals; delays in follow up appointments can and do occur. We aim to see if mean follow up intervals during the maintenance phase are correlated with visual outcomes at one year and perform a multivariate analysis of patient factors in a bit to understand the factors affecting visual acuity outcomes. METHOD: A continuously updated prospective audit of patients receiving ranibizumab therapy at the Royal Gwent Hospital was accessed and a coefficient of determination and Spearman's rank test undertaken to see whether mean follow up delays resulted in visual acuity penalties after nine months of maintenance. Multivariate analysis using ANOVA was then undertaken to examine in more detail the various factors affecting visual acuity outcomes. RESULTS: 805 eyes of 708 patients were included in the study. Mean follow up intervals varied between 28.0 and 96.3 days over the first six treatments of the maintenance phase (mean 49.2 - SD 10.7) with a mean change in visual acuity from baseline of +7.1 letters at 12 weeks and +4.6 letters at 52 weeks. There was a negative correlation seen between visual acuity gains after nine months of the maintenance phase and increasing clinic follow up times although Spearman's rank analysis demonstrated a correlation coefficient of only -0.078, which was not statistically significant. Variability in follow up appointments resulting in worse outcomes was however significant (p < 0.01), as was increasing age at presentation (p = 0.04). Smoking was found to decrease age of presentation by six years (74.2 years vs 80.0 years). The adjusted R (2) for the whole analysis was 0.44. CONCLUSION: Wide variation in follow up intervals was associated with a worse visual acuity outcome although longer mean follow up interval was not. Smokers presented at a significantly younger age than non-smokers or ex-smokers. This was a large study with an adjusted R (2) of 0.44. The results are relevant to other macular degeneration service providers around the world.

Iatrogenic extreme corneal decompensation treated by sequential Descemet's Stripping Endothelial Keratoplasty surgeries six months apart.

Descemet's stripping endothelial keratoplasty (DSEK) is now the most common surgical procedure to treat endothelial dysfunction although it is known that endothelial cell survival is an issue of concern. We present a case whereby severe iatrogenic corneal decompensation caused by Descemet's membrane detachment following premature disconnection of an infusion tube at the end of a trans pars plana vitrectomy and epiretinal membrane peel was successfully treated with two staged DSEK procedures six months apart. The patient was counselled that due to the severity of his extreme corneal oedema more than one DSEK procedure may be needed and the procedure was planned from the outset as a two-stage procedure. There was a measurable decrease in corneal thickness and increase in visual acuity following both the first and second procedures, which may be due to reinvigoration of the endothelial cell count following each procedure. We suggest that repeating the DSEK procedure, even when the first operation has gone well and the graft appears healthy, may be beneficial in obtaining further improvement in cases of severe corneal oedema.

A case of black magic.

The authors present the case of a 64-year-old woman who presented with massive subcutaneous emphysema 2 weeks after unknowingly inhaling a Brazil nut. Foreign body inhalation should be a differential diagnosis in all such patients, with computed tomography scanning of the chest being the most appropriate investigation.