Meibography health score: a simple grading system for isotretinoin-induced meibography alterations on patients with acne vulgaris

ABSTRACT Purpose: To develop a simple, subjective, and reliable grading scale for isotretinoin-induced meibography changes. Methods: After analyzing meibography images obtained from systemic isotretinoin users, a grading scale was proposed and named "meibography health score." The score ranged from 1 to 3, with decreasing gland reflectivity and identifiable margins. A total of 11 medical professionals were asked to grade 10 meibography images obtained from isotretinoin users using the proposed scale and were divided into three groups: (A) ophthalmologists with experience with meibography, (B) ophthalmologists with no experience with meibography, and (C) radiologists. The kappa statistic was determined to test interrater reliability. Results: The overall kappa was approximately 0.64. The kappa scores for Groups A, B, and C were 0.78, 0.59, and 0.90, respectively. Grade 2 had the lowest kappa scores (0.62, 0.35, and 0.82 for A, B, and C, respectively) and grade 3 the highest (0.78, 0.90, and 1.0 for A, B and C, respectively). Furthermore, Group C had the highest kappa scores and Group B the lowest. Conclusion: The meibography health score exhibited good interrater reliability, particularly in severe cases.

Evaluation of the quality and readability of ChatGPT responses to frequently asked questions about myopia in traditional Chinese language.

Introduction: ChatGPT can serve as an adjunct informational tool for ophthalmologists and their patients. However, the reliability and readability of its responses to myopia-related queries in the Chinese language remain underexplored. Purpose: This study aimed to evaluate the ability of ChatGPT to address frequently asked questions (FAQs) about myopia by parents and caregivers. Method: Myopia-related FAQs were input three times into fresh ChatGPT sessions, and the responses were evaluated by 10 ophthalmologists using a Likert scale for appropriateness, usability, and clarity. The Chinese Readability Index Explorer (CRIE) was used to evaluate the readability of each response. Inter-rater reliability among the reviewers was examined using Cohen's kappa coefficient, and Spearman's rank correlation analysis and one-way analysis of variance were used to investigate the relationship between CRIE scores and each criterion. Results: Forty-five percent of the responses of ChatGPT in Chinese language were appropriate and usable and only 35% met all the set criteria. The CRIE scores for 20 ChatGPT responses ranged from 7.29 to 12.09, indicating that the readability level was equivalent to a middle-to-high school level. Responses about the treatment efficacy and side effects were deficient for all three criteria. Conclusions: The performance of ChatGPT in addressing pediatric myopia-related questions is currently suboptimal. As parents increasingly utilize digital resources to obtain health information, it has become crucial for eye care professionals to familiarize themselves with artificial intelligence-driven information on pediatric myopia.

Intravitreal injection practice patterns among Chinese ophthalmologists.

AIM: To describe the practice patterns of intravitreal injections (IVIs) among ophthalmologists in China. METHODS: This was a cross-sectional online survey. Ophthalmologists who had performed accumulated more than 100 injections were contacted by the Brightness Center, a hospital-based national network, to complete an anonymous, 24-question, internet-based survey. They were surveyed on practices in injection techniques, pre-, and post-injections procedures. RESULTS: A total of 333 ophthalmologists from 28 provinces/municipalities/autonomous regions responded to the survey (50.68% response rate). The 91.29% of the respondents evaluated systemic risk factors by medical history, electrocardiogram (ECG) and blood test. All the respondents used pre-injection prophylactic antibiotics. Most checked intraocular pressure (IOP, 99.1%) and blood pressure (96.1%) before injections. A majority of the respondents performed injections in the operating room (98.8%), wore masks (99.7%), gloves (99.4%) and sterile surgical clothing (96.1%), performed topical anesthetics (97.9%), and applied povidone-iodine (95.8%) pre-injection. The 61.26% of the respondents dilated pupil. About half of the respondents (51.05%) performed bilateral injections in the same setting. Superior temporal quadrant (40.54%) was the most frequent site of injection. Around three quarters used 30-gauge needles. Most respondents (97.9%) measured the site of injection from limbus. More than half (53.45%) performed conjunctiva displacement prior to injection. The 32.43% of the respondents checked IOP post-injection and 87.99% physicians checked hand motion (HM) or counting fingers (CF) after injection, while 36.94% observed optic nerve perfusion. All participants used topical antibiotics post-injections. Most physicians (91.89%) reviewed patients on the following day. CONCLUSION: This study provides a description of the real-world practice patterns in IVIs in China and offers critical information regarding education and training of ophthalmologists and amendment of local society guidelines.

Current clinical practice and needs assessment in inherited eye diseases from the perspective of ophthalmologists.

BACKGROUND: The clinical approach to inherited eye diseases has evolved due to advances in genetic testing methods and treatment opportunities. However, no data are available on the current practices of ophthalmologists in countries, such as Turkey, with higher rates of consanguinity and inherited eye diseases. The aim of this study was to evaluate the current practices, knowledge, and needs of ophthalmologists in Turkey regarding inherited eye diseases. METHODS: A 29-item self-administered survey with a branching algorithm was developed through Google Forms. The survey link was sent to 2983 ophthalmologists in Turkey. The survey assessed respondents' occupational characteristics, current practices, knowledge about available diagnostic and therapeutic options, and opinions on improving continuing education and healthcare services. RESULTS: Responses from 414 ophthalmologists (20.8%) were analyzed. The responses suggested that ophthalmologists mainly collaborate with medical geneticists in respect of inherited eye diseases. The majority of ophthalmologists reported a lack of knowledge about genetic diagnostic tests, and approximately 90% of the ophthalmologists thought training after residency was inadequate for inherited eye diseases. CONCLUSION: This is the most extensive survey exploring ophthalmologists' practice patterns and needs in a setting without specialists or specialized centers in ophthalmic genetics. The results emphasize the need for continued education on updated approaches to inherited eye diseases.

Evaluation and management of nonarteritic anterior ischemic optic neuropathy: a national survey.

PURPOSE: The evaluation and management of Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) lacks standardized guidelines. This study aimed to investigate the real-world practices of neuro-ophthalmologists in the evaluation and management of typical NAION cases. METHODS: A national survey, conducted between 2019 and 2021, involved all practicing neuro-ophthalmologists. A structured questionnaire assessed their approach to risk factor evaluation and treatment of NAION, with 19 questions about risk factors and six questions concerning treatment and prevention of fellow-eye involvement. RESULTS: Thirty-six out of 37 neuro-ophthalmologists participated. Most physicians referred patients for evaluation of the following risk factors: obstructive sleep apnea (83.3%), diabetes mellitus (83.3%), hypertension (77.7%), dyslipidemia (72.2%), and optic disc drusen (38.8%). However, there was considerable variation in the choice of diagnostic tests recommended. Furthermore, nearly 47% recommended an embolism workup. Regarding treatment, the majority (91%) did not recommend routine treatment for NAION, although in 16.7%, high-dose corticosteroids were occasionally prescribed. Secondary prevention with aspirin (80.6%), smoking cessation advice (86.1%), and advising against erectile dysfunction medications for men (80.6%) were common recommendations. CONCLUSION: While the risk factors associated with NAION are well-reported, there is a lack of uniformity on which tests should be ordered to evaluate these risk factors. Most neuro-ophthalmologists concur that routine treatment for NAION is not warranted, but not unanimously. Future studies to develop a consensus guideline for post-NAION work-up and management recommendations may assist in the detection and management of preventable risk factors.

Exploring a Masters of Business Administration's Impact on Surgical Subspecialists.

Objectives and Study Design: As healthcare evolves, more physicians are taking on administrative roles and pursuing additional graduate education, particularly obtaining a Master's in Business Administration (MBA.) To facilitate a better understanding of these practitioners, we conducted a comparative study of MD/MBA clinicians in multiple surgical fields. Methods: This study aims to compare clinicians with MD/MBAs across multiple surgical subspecialties. Reported metrics include demographics, MBA program structure, salary changes, and professional pursuits. Nine studies were obtained from the PubMed, Cochrane, and Embase databases. Four studies met the inclusion criteria and were analyzed. Results: The majority of MD/MBA degree holders in plastic surgery (95%), orthopedic surgery (89-96%), and ophthalmology (80%) are male. Ophthalmology (37%) demonstrates the highest number of subjects obtaining an MBA via a synchronous MD/MBA. Most clinicians return to clinical practice after degree completion and show high levels of non-clinical pursuits after receiving their MBAs. Conclusions: Though there appear to be differences across surgical subspecialties regarding how an MBA is applied, most maintain clinical duties. Of those that do not, the largest portion transition to administrative duties, consulting, entrepreneurial endeavors, or other professional opportunities. Despite the financial ambiguity of an MBA, physicians value the transformative experience it offers.

Evaluation of Artificial Intelligence Algorithms for Diabetic Retinopathy Detection: Protocol for a Systematic Review and Meta-Analysis.

BACKGROUND: Diabetic retinopathy (DR) is one of the most common complications of diabetes mellitus. The global burden is immense with a worldwide prevalence of 8.5%. Recent advancements in artificial intelligence (AI) have demonstrated the potential to transform the landscape of ophthalmology with earlier detection and management of DR. OBJECTIVE: This study seeks to provide an update and evaluate the accuracy and current diagnostic ability of AI in detecting DR versus ophthalmologists. Additionally, this review will highlight the potential of AI integration to enhance DR screening, management, and disease progression. METHODS: A systematic review of the current landscape of AI's role in DR will be undertaken, guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) model. Relevant peer-reviewed papers published in English will be identified by searching 4 international databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Eligible studies will include randomized controlled trials, observational studies, and cohort studies published on or after 2022 that evaluate AI's performance in retinal imaging detection of DR in diverse adult populations. Studies that focus on specific comorbid conditions, nonimage-based applications of AI, or those lacking a direct comparison group or clear methodology will be excluded. Selected papers will be independently assessed for bias by 2 review authors (JS and DM) using the Quality Assessment of Diagnostic Accuracy Studies tool for systematic reviews. Upon systematic review completion, if it is determined that there are sufficient data, a meta-analysis will be performed. Data synthesis will use a quantitative model. Statistical software such as RevMan and STATA will be used to produce a random-effects meta-regression model to pool data from selected studies. RESULTS: Using selected search queries across multiple databases, we accumulated 3494 studies regarding our topic of interest, of which 1588 were duplicates, leaving 1906 unique research papers to review and analyze. CONCLUSIONS: This systematic review and meta-analysis protocol outlines a comprehensive evaluation of AI for DR detection. This active study is anticipated to assess the current accuracy of AI methods in detecting DR. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57292.

Ophthalmology Census 2021: A Demographic Characterisation of Ophthalmologists in Portugal.

INTRODUCTION: Human resources in ophthalmology have recently received particular attention, and it has been questioned whether there is a sufficient number of workers. The aim of this study was to analyze and characterize Portugal's ophthalmologist population. METHODS: In this descriptive, cross-sectional study, an online questionnaire was sent to all ophthalmologists registered with the Portuguese College of Ophthalmology in December 2021. Information on the following variables was collected and analyzed: demographic factors, professional qualifications, professional activity, weekly professional activity and medium-term plans. RESULTS: Among the 910 registered ophthalmologists, a response rate of 64.7% was achieved. There were 0.9 ophthalmologists for every 10 000 inhabitants, 0.45:10 000 working in the public sector (0.35:10 000 full-time equivalent). Among the respondents, 57.6% were over 50 years old (59.6% male), 97.3% were Portuguese, 46.7% completed their residency in the Lisbon region, 27.3% complemented their programme with additional training, 9.5% had a PhD and approximately 58% lived and worked in large urban centres. Regarding professional activity, 58.5% of the respondents worked in the public sector (4.2% exclusively), while 67.9% worked in different economic sectors. The median number of weekly working hours reported was 45 hours, with those in the public sector reporting 35 hours. Private/social sector work and public sector work accounted for 12 926 hours/week and 10 808 hours/week, respectively. It was found that 31.4% of the respondents provided emergency medical services and that 52.8% performed surgical procedures more than once a week. Looking ahead, 38.7% of the ophthalmologists intended to reduce their workload within the next five years due to family reasons, fatigue and demotivation. The projected rate of retirement or cessation of activity in the next five years was estimated to be 1.7%, while an average of 20 new ophthalmologists are expected to enter the profession annually, resulting in a generational balance of 0.8%. CONCLUSION: While the number of ophthalmologists in Portugal meets the international recommendations, there is a shortage in the public sector and most ophthalmologists work in large urban centres. The number of ophthalmologists in Portugal is expected to be stable for the next five years.

Are artificial intelligence chatbots a reliable source of information about contact lenses?

INTRODUCTION: Artificial Intelligence (AI) chatbots are able to explain complex concepts using plain language. The aim of this study was to assess the accuracy of three AI chatbots answering common questions related to contact lens (CL) wear. METHODS: Three open access AI chatbots were compared: Perplexity, Open Assistant and ChatGPT 3.5. Ten general CL questions were asked to all AI chatbots on the same day in two different countries, with the questions asked in Spanish from Spain and in English from the U.K. Two independent optometrists with experience working in each country assessed the accuracy of the answers provided. Also, the AI chatbots' responses were assessed if their outputs showed any bias towards (or against) any eye care professional (ECP). RESULTS: The answers obtained by the same AI chatbots were different in Spain and the U.K. Also, statistically significant differences were found between the AI chatbots for accuracy. In the U.K., ChatGPT 3.5 was the most and Open Assistant least accurate (p < 0.01). In Spain, Perplexity and ChatGPT were statistically more accurate than Open Assistant (p < 0.01). All the AI chatbots presented bias, except ChatGPT 3.5 in Spain. CONCLUSIONS: AI chatbots do not always consider local CL legislation, and their accuracy seems to be dependent on the language used to interact with them. Hence, at this time, although some AI chatbots might be a good source of information for general CL related questions, they cannot replace an ECP.

Wait Times for Scheduling Appointments for Prevention of Macrovascular and Microvascular Complications of Diabetes: Cross-Sectional Descriptive Study.

BACKGROUND: Diabetes is a chronic disease that requires lifelong management and care, affecting around 422 million people worldwide and roughly 37 million in the United States. Patients newly diagnosed with diabetes must work with health care providers to formulate a management plan, including lifestyle modifications and regular office visits, to improve metabolic control, prevent or delay complications, optimize quality of life, and promote well-being. OBJECTIVE: Our aim is to investigate one component of system-wide access to timely health care for people with diabetes in New York City (NYC), namely the length of time for someone with newly diagnosed diabetes to obtain an appointment with 3 diabetes care specialists: a cardiologist, an endocrinologist, and an ophthalmologist, respectively. METHODS: We contacted the offices of 3 different kinds of specialists: cardiologists, endocrinologists, and ophthalmologists, by telephone, for this descriptive cross-sectional study, to determine the number of days required to schedule an appointment for a new patient with diabetes. The sampling frame included all specialists affiliated with any private or public hospital in NYC. The number of days to obtain an appointment with each specialist was documented, along with "time on hold" when attempting to schedule an appointment and the presence of online booking capabilities. RESULTS: Of the 1639 unique physicians affiliated with (private and public) hospitals in the 3 subspecialties, 1032 (cardiologists, endocrinologists, and ophthalmologists) were in active practice and did not require a referral. The mean wait time for scheduling an appointment was 36 (SD 36.4; IQR 12-51.5) days for cardiologists; 82 (SD 47; IQR 56-101) days for endocrinologists; and 50.4 (SD 56; IQR 10-72) days for ophthalmologists. The median wait time was 27 days for cardiologists, 72 days for endocrinologists, and 30 days for ophthalmologists. The mean time on hold while attempting to schedule an appointment with these specialists was 2.6 (SD 5.5) minutes for cardiologists, 5.4 (SD 4.3) minutes for endocrinologists, and 3.2 (SD 4.8) minutes for ophthalmologists, respectively. Over 46% (158/341) of cardiologists enabled patients to schedule an appointment on the web, and over 55% (128/228) of endocrinologists enabled patients to schedule an appointment on the web. In contrast, only approximately 25% (117/463) of ophthalmologists offered web-based appointment scheduling options. CONCLUSIONS: The results indicate considerable variation in wait times between and within the 3 specialties examined for a new patient in NYC. Given the paucity of research on wait times for newly diagnosed people with diabetes to obtain an appointment with different specialists, this study provides preliminary estimates that can serve as an initial reference. Additional research is needed to document the extent to which wait times are associated with complications and the demographic and socio-economic characteristics of people served by different providers.

Burnout syndrome in Spanish, Portuguese and Latin American ophthalmologists: a cross-sectional analysis.

PURPOSE: Despite the well-known consequences of burnout syndrome, there has been little research into this syndrome in the field of ophthalmology. Our objective is to determine the frequency of burnout syndrome between Spanish, Portugal and Latin-American ophthalmologists, as well as to analyse its relationship with different sociodemographic variables. METHODS: This is an observational cross-sectional descriptive study including ophthalmologists from Spain, Portugal and 15 Latin American countries. Burnout syndrome was evaluated by the Maslach Burnout Inventory-Human Services Survey. Burnout syndrome was defined as high emotional exhaustion, high depersonalization or low personal accomplishment. In addition, we recorded sociodemographic variables and aspects related to the type of work. A conditional backwards stepwise multivariate binomial logistic regression analysis was run to assess the variables associated with burnout syndrome, expressed as an odds ratio (OR). RESULTS: A total of 527 surveys were analysed, the majority from Spain (401; 76.1%), followed by Argentina (45; 8.5%), and Mexico (31; 5.9%). The number of ophthalmologists with burnout syndrome was 351 (66.6%). The results show the profile of a young ophthalmologist (age OR 0.985), carrying out a public activity (OR 2.118) and dedicated to general ophthalmology (OR 1.860). CONCLUSIONS: The frequency detected in this study confirms a steady increase in rates of burnout among ophthalmologists. As the consequences of this are well known, it is vital for health centre managers to develop a strategic plan to allow the causes to be understood better and to implement steps to improve the situation in each medical centre.

Leadership in ophthalmology by humanity and competence.

Leadership in healthcare institutions has a direct impact on the practice of the medical and nursing professions. The respective leadership style that is cultivated in a medical institution therefore has a direct impact on the personnel and thus a direct impact on the treatment of patients, in both senses of the word. Leadership in healthcare should therefore inspire, motivate, and guide healthcare workers to use their individual and collective skills as well as the available resources in the best possible way for the benefit of patients. This is the task and obligation of all those working in the healthcare system. The German Society of Ophthalmology (DOG) has established a leadership academy for ophthalmologists to meet the requirements of the modern healthcare market for leadership qualifications.

Ophthalmologists' Attitudes, Knowledge, and Willingness to Report Child Abuse.

The aim of the present study was to explore ophthalmologists' attitudes, knowledge, and willingness to report child abuse. One-hundred-and-seven ophthalmologists employed in various hospitals in Israel completed an online questionnaire. Less than half the ophthalmologists (44.9%) reported that they had treated children whom they identified or suspected as being victims of child abuse, while only 43.9% of these reported child abuse. Despite generally positive attitudes towards reporting of child abuse among the ophthalmologists, their average level of knowledge was low. Ophthalmologists who had received training on child abuse and residents displayed a higher level of knowledge. In addition, female ophthalmologists tended to agree more that ophthalmologists are obligated to screen for and report child abuse. Moreover, female ophthalmologists expressed higher willingness to report child abuse. The present study reveals that underreporting of child abuse, and more precisely the discrepancy between identification and reporting, is present among ophthalmologists. It seems that lack of knowledge regarding identification and reporting of child abuse is the main barrier to reporting, especially among medical specialists. These findings underscore the importance of training programs on child abuse, both during formal education in medical school, and post-qualification, for all ophthalmologists, irrespective of seniority.

Patient Demand for Ophthalmologists in the United States: A Google Trends Analysis.

PURPOSE: To study geographic patterns in ophthalmologist supply and patient demand for services in the United States. METHODS: Google Trends data for the keywords "ophthalmology" and "ophthalmologist" between 2004 and 2019 were queried and normalized to determine relative search volumes (RSV) for each United States state. Ophthalmologist density was calculated by dividing the number of practicing ophthalmologists by the State Census Bureau population estimates. RSV values were divided by ophthalmologist density and normalized to calculate the relative demand index (RDI) for each state. The number of accredited ophthalmology programs per state was acquired through the Accreditation Council for Graduate Medical Education. RESULTS: Ophthalmologist concentration was highly heterogeneous across the country. The states with the highest concentration of ophthalmologist per 10,000 people were Washington, DC (1.42), Maryland (0.94), Massachusetts (0.87), and New York (0.86), while the lowest were Wyoming (0.19), Idaho (0.36), New Mexico (0.38), and Nevada (0.39). RSVs ranged from 36 (Alaska and North Dakota) to 100 (Michigan). The highest RDI was found in South Dakota (100), Delaware (84), Michigan (66), and Arizona (56). The lowest RDI was in Washington, DC (0), Hawaii (7), Oregon (8), and Montana (14). The highest number of ophthalmology residency programs were in New York (18), Texas (9), and California (9), whereas 12 states lacked residency programs altogether. CONCLUSIONS: In this study, we found a wide range in the geographic distribution of ophthalmologists and residency programs in the United States. States with the highest relative demand index may represent areas most at risk of unmet medical needs.

Myopia management -A survey of optometrists and ophthalmologists in Israel.

PURPOSE: Myopia management is practiced by ophthalmologists and optometrists. This study evaluated the approach and standard of myopia management among eye-care practitioners (ECPs) in Israel. The findings may ultimately affect the quality of care. METHODS: A questionnaire was sent to 954 optometrists and 365 ophthalmologists, including demographic questions; whether they owned any devices to monitor myopia progression; the lowest progression they considered significant; various questions pertaining to myopia management and treatment methods. RESULTS: Responses from 135 optometrists and 126 ophthalmologists were collected, the majority practicing more than five years; 94% of optometrists, and 64% of ophthalmologists. Around 53% of optometrists and 27% of the ophthalmologists proclaimed to practice myopia management. ECPs primary parameters influencing risk assessment for progression were age, genetic background and history of progression. Time outdoors, during daylight hours, is advised by ophthalmologists (97%) and optometrists (78%). Limiting screentime is encouraged by 87% of ophthalmologists and 69% of optometrists. Myopia progression of 0.50D-0.75D after six months is regarded to require intervention by 93% of ophthalmologists and 83% of optometrists. Optometrists selected multiple myopia management treatments, primarily optical (ophthalmic myopia management lenses 40%, multifocal ophthalmic lenses 24%, peripheral blur contact lenses 38%, orthokeratology 11%), while 95% of ophthalmologists chose atropine and only 3-11% selected any additional treatments to consider. CONCLUSION: This study highlighted ECPs' agreement on the principles, importance of, and timeline of intervention with myopia management. The disconnect between the two professions lies in management methods. Genuine dialogue and co-management should be encouraged for maximum implementation, benefit and effectiveness of available patient treatments.

Analysis of the Association between Retinal Artery Occlusion and Acute Ischaemic Stroke/ST-Elevation Myocardial Infarction and Risk Factors in Hungarian Patients.

Background and Objectives: We aimed to analyse data on retinal artery occlusion (RAO) patients to explore correlations with acute ischaemic stroke (AIS), ST-elevation myocardial infarction (STEMI), and cardio/cerebrovascular comorbidities. Patients and Methods: Our retrospective cohort study included 169 RAO and 169 age- and gender-matched control patients. We examined the association of AIS, STEMI, and related comorbidities such as hypertension (HT), type 1 and type 2 diabetes (T1DM and T2DM, respectively), hyperlipidaemia, and ischaemic heart disease (IHD) with RAO. We also recorded atrial fibrillation in our RAO patients. Results: Our results demonstrated that RAO patients developed both AIS and STEMI at a significantly higher rate compared to controls (p < 0.001 for both). We also found that RAO patients had a significantly higher prevalence of HT and hyperlipidaemia (p1 = 0.005, p2 < 0.001) compared to controls. Multiple risk factors together significantly increased the odds of developing AIS and STEMI. Conclusions: Our results suggest that through identifying and treating the risk factors for RAO patients, we can reduce the risk of AIS, STEMI, and RAO of the fellow eye. Considering that ophthalmologists are often the first detectors of these cardiovascularly burdened patients, collaboration with colleagues from internal medicine, cardiology, and neurology is essential to achieve secondary prevention.

[Leadership in ophthalmology by humanity and competence]. / Führung in der Augenheilkunde durch Menschlichkeit und Kompetenz.

Leadership in healthcare institutions has a direct impact on the practice of the medical and nursing professions. The respective leadership style that is cultivated in a medical institution therefore has a direct impact on the personnel and thus a direct impact on the treatment of patients, in both senses of the word. Leadership in healthcare should therefore inspire, motivate, and guide healthcare workers to use their individual and collective skills as well as the available resources in the best possible way for the benefit of patients. This is the task and obligation of all those working in the healthcare system. The German Society of Ophthalmology (DOG) has established a leadership academy for ophthalmologists to meet the requirements of the modern healthcare market for leadership qualifications.

Optometrists' Perspectives Regarding Artificial Intelligence Aids and Contributing Retinal Images to a Repository: Web-Based Interview Study.

BACKGROUND: A repository of retinal images for research is being established in Scotland. It will permit researchers to validate, tune, and refine artificial intelligence (AI) decision-support algorithms to accelerate safe deployment in Scottish optometry and beyond. Research demonstrates the potential of AI systems in optometry and ophthalmology, though they are not yet widely adopted. OBJECTIVE: In this study, 18 optometrists were interviewed to (1) identify their expectations and concerns about the national image research repository and their use of AI decision support and (2) gather their suggestions for improving eye health care. The goal was to clarify attitudes among optometrists delivering primary eye care with respect to contributing their patients' images and to using AI assistance. These attitudes are less well studied in primary care contexts. Five ophthalmologists were interviewed to discover their interactions with optometrists. METHODS: Between March and August 2021, 23 semistructured interviews were conducted online lasting for 30-60 minutes. Transcribed and pseudonymized recordings were analyzed using thematic analysis. RESULTS: All optometrists supported contributing retinal images to form an extensive and long-running research repository. Our main findings are summarized as follows. Optometrists were willing to share images of their patients' eyes but expressed concern about technical difficulties, lack of standardization, and the effort involved. Those interviewed thought that sharing digital images would improve collaboration between optometrists and ophthalmologists, for example, during referral to secondary health care. Optometrists welcomed an expanded primary care role in diagnosis and management of diseases by exploiting new technologies and anticipated significant health benefits. Optometrists welcomed AI assistance but insisted that it should not reduce their role and responsibilities. CONCLUSIONS: Our investigation focusing on optometrists is novel because most similar studies on AI assistance were performed in hospital settings. Our findings are consistent with those of studies with professionals in ophthalmology and other medical disciplines: showing near universal willingness to use AI to improve health care, alongside concerns over training, costs, responsibilities, skill retention, data sharing, and disruptions to professional practices. Our study on optometrists' willingness to contribute images to a research repository introduces a new aspect; they hope that a digital image sharing infrastructure will facilitate service integration.

Management of orbital floor fractures in France: Results of a national online survey.

INTRODUCTION: Orbital floor fractures (OFF) are common facial trauma injuries, and there are no official guidelines for their medical and surgical management. The aim of this study was to provide an overview of the management of OFF in France. MATERIALS AND METHODS: An online questionnaire was sent to 144 surgeons at the 88 French centers involved in the management of OFF (2019 data from the National Health Insurance Body). The questions related to the preoperative clinical and radiographic examinations, the criteria for surgical indication, the materials used, and the elements of the postoperative period. RESULTS: Ultimately, 42 questionnaires were analyzed (32 from oral and maxillofacial surgeons (OMFS), 8 from ophthalmologists, and 2 from ENT or plastic surgeons). For 69% of the surgeons, a systematic ophthalmological examination was carried out, 3-7 days after the trauma, and based on a Lancaster test or visual acuity (97.6% and 83.3% of the responders, respectively). The most important criteria for the therapeutic decision were diplopia or oculomotor disorder that persisted for more than 7 days (76.2%), clinical enophthalmos (54.8%), a large fracture (52.4%), and ptosis of the orbital content on CT scan (38.1%). The mean surgical delay was 7-15 days for 54.8% of the responders. Resorbing sheets were the preferred materials to repair small fractures, while larger fractures required alloplastic implants (titanium mesh). CONCLUSION: This survey confirms the diversity of practices in France regarding the management of OFF. Further studies are needed before guidelines can be developed.