[Analysis of the importance of e-learning in ophthalmology and evaluation of an e-learning app]. / Analyse des Stellenwertes von "eLearning" in der Augenheilkunde und Evaluierung einer "eLearning-App".

BACKGROUND: The aim of the study was to analyze the importance of e­learning in the learning and training behavior of ophthalmologists in Germany and to evaluate the acceptance of a new e­learning user software (app). MATERIAL AND METHODS: Ophthalmological residents and specialists were asked about continuing education activities by means of a questionnaire during continuing education events. Furthermore, a structured evaluation was carried out after the presentation and application of an e­learning app. RESULTS: A total of 149 ophthalmologists took part in the survey. While the majority of colleagues (74.3%) used specialist journals weekly or monthly for further education, 45.9% of ophthalmologists used digital print media (books, journals, articles) and 46.5% used specialist books in printed form. Only 35% of the interviewees used online training platforms, e.g. digital courses (CME courses) or portals for retrieving recorded lectures. The use of the offered e­learning app was generally accompanied by a positive acceptance. Of the interviewed colleagues 91.7% would recommend this form of interactive learning. DISCUSSION: Despite a progressive digitalization in all areas of life, e­learning continues to play a minor role as a learning medium in ophthalmological advanced training. Interestingly, the evaluation of app users showed a high level of acceptance, regardless of age or field of work.

Prospective PED-study of intravitreal aflibercept for refractory vascularized pigment epithelium detachment due to age-related macular degeneration: morphologic characteristics of non-responders in optical coherence tomography.

PURPOSE: The aim of this study was to investigate the outcomes of a fixed intravitreal aflibercept regimen in patients with vascular pigment epithelium detachment (vPED) secondary to age-related macular degeneration with refractory subretinal fluid. METHODS: A prospective, interventional case series involved 20 eyes of 20 patients with refractory subretinal fluid and vPED treated with at least three injections of intravitreal anti-VEGF prior to study inclusion. After study inclusion, patients were treated with three injections of intravitreal aflibercept 2 mg/0.05 mL monthly followed by injections every 8 weeks. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) were evaluated at all visits. Fluorescein angiography and indocyanine green angiography were performed at baseline and quarterly. Primary outcomes were effectivity of a fixed treatment as measured in change in BCVA, PED greatest linear diameter (GLD), and PED height from baseline to month 12. In an additional post hoc analysis, vPED patients were differentiated into two groups: (1) vPED lesions that showed persistence of subretinal fluid throughout 1 year of treatment and (2) vPED lesions that showed complete resolution of subretinal fluid at least at one of the monthly performed OCT volume scans. Reflectivity values were determined in the subretinal pigment epithelium (RPE) compartment in OCT scans at baseline, month 6 and 12. RESULTS: A total of 18 patients completed the study protocol. The mean age was 74.8 ± 10.6 years, and six patients were female. The median BCVA of all patients was 72.0 ± 8.0 EDTRS letters at baseline and 72.5 ± 9.5 EDTRS letters at 12-month follow-up (p = 0.7420). The median PED height in all patients as measured in the OCT images significantly decreased from 372.0 ± 140.0 µm to 149.0 ± 142.0 µm after 12 months of treatment (p = 0.0020). Persistent subretinal fluid was present at every OCT control in six patients (group 1). Twelve patients showed resolution of subretinal fluid at least at one OCT control (group 2). Reflectivity values in the sub-RPE compartment in OCT scans were 41.48 ± 4.48 (group 1) and 42.62 ± 12.34 (group 2) at baseline (p = 0.854) and 65.88 ± 6.74 and 50.87 ± 14.11 at month 12 (p = 0.038). CONCLUSIONS: Intravitreal aflibercept in refractory vPED leads to a significant reduction in PED height and disease activity as well as preservation of BCVA over 1 year. Persistent subretinal fluid was present in PED lesions with high values of reflectivity under the RPE, suggesting both a diffusion barrier and an increasing fibrovascular maturization of the choroidal neovascularization. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03370380.

[Ease of handling of first and second generation rebound tonometers]. / Handhabung von Reboundselbsttonometern der ersten und zweiten Generation.

PURPOSE: To evaluate the ease of handling of two rebound tonometers, which are designed for self-measurement of intraocular pressure (IOP) in a clinical setting by untrained patients. METHODS: After self-measurement of the IOP with the rebound tonometers iCare ONE and iCare HOME, participants were asked to complete a questionnaire containing different subitems concerning ease of operation using a visual analog scale (1 = very good to 5 = very poor). Moreover, the feasibility and duration of measurement were tested. RESULTS: A total of 147 subjects participated in this study. The mean score for general handling ability was 2.79 ± 1.01 for the iCare ONE and 1.85 ± 0.87 for the iCare HOME (p < 0.001). The evaluation of the subitems sense of safety (iCare ONE: 2.71 ± 1.03 and iCare HOME: 1.87 ± 0.81, p < 0.001) and comfort of measurement (iCare ONE: 2.07 ± 1.01 and iCare HOME: 1.66 ± 0.72, p < 0.001) also showed a significant discrepancy between the two tonometers. Participants needed significantly less time for a single valid measurement when using the iCare HOME tonometer (mean 66.14 ± 61.54 s) compared to the iCare ONE tonometer (mean 81.54 ± 69.51 s, p < 0.001). CONCLUSIONS: A better handling of the iCare HOME rebound tonometer in comparison to the iCare ONE tonometer can be deduced on the basis of the subjective assessments of patients and the shorter duration of measurements. Moreover, the iCare HOME received a significantly better evaluation for all subitems. The accuracy of measurements using the iCare HOME still needs to be clarified.