Historical evolution of the passenger ship's doctor.

The authors examine the evolution of the role of resident doctors on cruise ships dating back to the Roman and Byzantine empires, then in the Middle ages. In the past surgery was rarely performed by doctors, but by barber-surgeons, who, with their razor skills, did everything from haircuts to amputations. More recently, as in the last century, the first royal decrees were issued, pillar by pillar, forming the regulatory basis governing health care on board Italian or foreign ships travelling to and from national ports.

Efficacy and safety of intravitreal Fluocinolone Acetonide microimplant (ILUVIEN®) in patients with chronic diabetic macular edema: 1 year follow-up.

PURPOSE: Evaluate the efficacy and safety of intravitreal 0.19 mg fluocinolone acetonide (FAc) micro implant in patients with chronic diabetic macular edema (cDME). METHODS: Prospective study recruiting subjects with cDME. Inclusion criteria: cDME for at least 2 years documented with OCT imaging; pseudophakia; previous treatments with laser photocoagulation and intravitreal injections of anti-VEGF and/or dexamethasone. Exclusion criteria: phakia; ocular hypertension; tractional component visible on OCT; glaucoma; previous vitrectomy. Outcome measures included best-corrected visual acuity (BVCA), intraocular pressure (IOP), and central macular thickness (CMT), measured 1, 3, 6, and 12 months post-injection. Data were compared with the Friedman test and significance was set at p < 0.05. RESULTS: A total of 18 eyes with a median duration of cDME of 45 months (25-118 months). The 77% of subjects either maintained or improved their BVCA. About 17% and 33% of subjects showed an improvement of 15 ETDRS letters or more at 3 and 12 months respectively. The 17% and 28% of subjects showed a CMT <250 microns at 3 and 12 months, respectively. The median change in CMT thickness was of -370 and -373.5 microns at 3 and 12 months post-injection respectively (p-value is 0.025). Changes in median IOP at 3 and 12 months post-injection were not statistically significant (p-value is 0.210). Ocular hypertension (OHT) was detected in two eyes (11%). CONCLUSION: The FAc micro implant has proved efficacy in improving and/or maintaining BVCA in 77% of patients with cDME up to 12 months post-injection. Ocular hypertension is the most common side effect but responds well to topical therapy.

Retrospective study on the incidence of pseudoexfoliatio lentis and related complications in a cohort of patients from the Island of Ischia: medico-legal and ergophthalmology considerations.

The population of the island has lived for centuries almost isolated from the rest of the continental population. In the seventh century BC, it was the first Greek colony in the southern Italy and was colonized by the Eubei, then it was the turn of the Roman rule. In the Middle Ages, the island was the victim of many raids of the Barbary pirates. Only in the last decades of the 800, did the island begin to open to tourism. However, it had a strong setback with the terrible earthquake of Casamicciola, in 1883. Tourism had gradually resumed in the second post-war period. These episodes have contributed to bringing people extraneous to the autochthonous community to the island. As in most of the coastal populations of the Mediterranean basin, there is a very high incidence of pseudoexfoliation lentis in the population of Ischia, which is a syndrome that often complicates in a challenging way the surgical intervention for the removal of cataracts.

Law and order of modern ophthalmology: Teleophthalmology, smartphones legal and ethics.

In recent years, new technologies used in the field of ophthalmology have been emerging and developing rapidly. Two major aspects of these advancements are teleophthalmology and smartphones, which have enabled practitioners to achieve optimal outcomes in record time with minimal costs. Several rules and regulations have been applied to these technologies in order to frame them under the appropriate medico-legal ethics, and specialized committees have been dedicated to maintaining their efficacy and avoiding shortcomings. In addition multiple studies and case reports conducted worldwide have assessed them according to specific diseases or global concerns. This review article constitutes an up-to date account of almost all of the applications and medico-legal perspectives of technologies used in ophthalmology in order to summarize and better visualize their advantages and disadvantages.

The pathogenesis of cataract in professional workers exposed to solar radiation in marine environment.

In this article we presented the results on the cataract obtained in patients recruited during a period of two years in the social and labor ophthalmology ambulatory of Sapienza University in Rome. The first of two homogeneous populations (regarding the number of patients, age, profession, constant exposure to sunlight, same living habitat, geographical areas with similar intrinsic and extrinsic risk factors) involved the areas of the gulf of Pozzuoli and the gulf of Olbia, both of which are located at 40.5-41 degrees north latitude on the sea. The first place is located on the European continent and the other one on a medium-large island with particular genetic factors. The second of the two homogeneous populations involved the island of Ischia (NA) and the maritime professional activities carried out in Villasimius (CA) and surroundings, respectively at 40- and 39-degrees north latitude on the sea. The first is a medium-small island and the second one is located on a medium-large island, but both are in the middle of the Mediterranean Sea and are characterized by a certain degree of genetic isolation.

Medical legal validity of the use of the anomaloscope in the dyschromatopsia of aspiring civil and military aircraft pilots.

Color blindness is a condition of altered color perception, scientifically defined as "dyschromatopsia". Color blindness affects 8% of the world population. Color blindness is caused by an alteration of the cones that influences the vision of the color self (red, green, blue). A comparative study was conducted in dischromatopsic subjects identified during the course of the ordinary investigations directed towards the civil aero-navigating personnel by the Ophthalmology Department of the Air Force, between March 2019 and January 2020, at "Aldo Di Loreto" Institute of Aeronautical and Space Medicine of Rome. 10 subjects aged 20 to 50, with dyschromatopsia found at Ishihara's pseudoisochromatic tables, were submitted to Oculus HMC-Anomaloscope with a manual execution program and then a CAD test. Thus, in 2 out of 10 cases of dyschromatopsia, the Anomaloscope would have guided the medical judgement, while the CAD test would have oriented towards a judgment of full fitness despite the same lack of chromatic sensitivity however, underlined by both tests. In conclusion, the CAD test confirmed a highly sensitive and specific method of determining the presence and depth of the chromatic perception deficit but also the method was able to prevent the unjust refusal of certain air navigation activities to the aspirant staff.

Medical and legal aspects of telemedicine in ophthalmology.

Telemedicine provides adequate medical assistance for physically distant patients by using the Information and Communication Technologies (ICT). Telemedicine includes techniques and tools for health monitoring and care implemented through systems providing rapid access to both specialists and patients. Telemedicine may link human and economic resources. Telemedicine may facilitate the access of patients to specialized healthcare in places lacking qualified personnel or in remote or difficult access areas thus reducing long waiting lists and high costs for the health systems. Telemedicine projects between different countries are developing, but ethical and legal issues are emerging. This article refers to telemedicine as a broad concept of distance medicine. The main purpose will be the medical-legal aspects. We will also describe the telemedicine in ophthalmology and the main issues raised by its implementation.