Improving Medical Students' Awareness About Retinoblastoma: A Practical Strategy.

Background: Eye salvage and survival for patients with retinoblastoma (RB) can be improved by enhancement of early diagnosis. This study aims to investigate the impact of modifying the teaching curriculum for medical students about awareness of this condition. Methods: Medical students completed a questionnaire about RB, preluded by a photograph of a child with leukocoria. Participants were divided into group A (138 participants) and group B (151 participants) who are medical students who have completed the ophthalmology rotation before and after implementing modifications on teaching curriculum that focuses on the red flags of RB consecutively. Results: Most participants considered leukocoria an abnormal sign. Group A had significantly lower knowledge about diagnosis for RB (P=0.0001). Participants scored higher in group B for the critical questions, such as knowing that RB is a fatal disease (P=0.041) that needs urgent treatment (P=0.042). Only three (2%) students adopted the "watch and wait" strategy in group B, compared to 16 (12%) in group A (P=0.0013). Overall, proficiency score (≥90%) was achieved by 12 (8%) students in group B, but only three (2%) students in group A. Only 41 (27%) students in group B, compared to 90 (65%) students in group A, failed to obtain a sufficiency score (≥70%) in the questionnaire. Conclusion: Modifying the teaching curriculum of the ophthalmology rotation with an intensified focus on awareness of the life-threatening condition retinoblastoma improved medical students' knowledge of this malignancy. This intervention is one of the modalities that can lead to a reduction in diagnosis and referral delays and improvement in outcome and survival.

Optical Coherence Tomography Angiography in Healthy Adult Subjects: Normative Values, Frequency, and Impact of Artifacts.

Aim: This cross-sectional study is aimed at identifying normative ocular coherence tomography angiography (OCTA) values in a cohort of healthy adult Jordanian individuals and assessing the prevalence of different image artifacts and their impact on quantitative OCTA measurements. Materials and Methods: One hundred and eighty-one eyes from 100 healthy participants were included in this study. All participants underwent a comprehensive ophthalmological examination including best corrected visual acuity, slit lamp examination, and dilated fundoscopy. Swept-source OCTA images were obtained and analyzed for all 181 eyes. We recorded vascularity measurements and analyzed the prevalence and effect of ten different artifacts on superficial and deep retinal and choriocapillaris layer images. Results: Sixty-two percent of the participants were men (n = 62), and 38% (n = 38) were women. The age of participants ranged between 24 and 75 years (mean 50.5 ± 10.92). The mean central macular thickness was 237.71 (±22.905) µm, and the mean choroidal thickness was 257.73 (±77.027) µm. Artifacts were present in 46.4% of the acquired scans. Images with artifacts had higher mean age (p = 0.03), lower image quality (p < 0.001), higher central vascular density (p < 0.001), and lower inferior vascular density (p < 0.001) compared to artifact-free tomographs. Motion artifact was the most common type, which was present in 29 (16%) of images, followed by blink artifact 18 (9.9%), and Z offset 8 (4.4%). Conclusion: OCTA artifact detection and correction remains a challenging aspect of the diagnostic and follow-up process of patients with retinal pathologies. To our knowledge, this is the first study to examine the association between OCTA outputs and artifacts in healthy eyes. We report that in this cohort of normal individuals, images with artifacts had a significantly higher central vascular density (22.62 vs. 16.60) and a lower inferior vascular density (46.09 vs. 48.81). We also found that a significant increase in central vascular density is only present in images with Z offset artifact type (49.03). Motion artifact was the most common artifact seen in our series. However, we observed no alteration in quantitative parameters in images with motion artifacts.

Retinoblastoma awareness among first contact physicians in Jordan.

Background: Early diagnosis and timely management of Retinoblastoma (RB) patients are essential to improve eye salvage and survival rates. The objective of this study is to evaluate the level of knowledge regarding retinoblastoma among first-contact physicians, namely students in last year of medical school, pediatricians, and ophthalmologists. Methods: A questionnaire about RB, preluded by a photograph of a child with leukocoria was completed by 138 medical students, 65 pediatricians, and 65 ophthalmologists. Descriptive statistics from the population were obtained and all answers were analyzed. Results: The majority (n = 253, 94%) of participants in the 3 groups recognized leukocoria as an abnormal sign. However, 62 (45%) medical students did not recognize it as a sign of a life-threatening disease. Only 3 (2%) medical students, 1(2%) pediatrician, and 9 (14%) ophthalmologists achieved a proficiency grade, compared to 136 (67%) medical students and pediatricians who failed to achieve the sufficiency score (70%) in this questionnaire. Ophthalmologists showed a better level of knowledge about RB than medical students and pediatricians, however, 27(42%) of them failed to achieve the sufficiency score. Of interest, only 72 (52%) of medical students, 41 (63%) of pediatricians, and 46 (71%) of ophthalmologists knew that RB needs urgent management. Conclusion: Most medical students and pediatricians involved in this study lack the sufficient knowledge to detect and timely-refer patients with signs of RB. It is necessary to develop continuous medical education programs for first-contact physicians.