Survey of ophthalmology
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Survey of ophthalmology · Jan 2018
ReviewClinical decision-making: heuristics and cognitive biases for the ophthalmologist.
Diagnostic errors have a significant impact on health care outcomes and patient care. The underlying causes and development of diagnostic error are complex with flaws in health care systems, as well as human error, playing a role. ⋯ We describe these mechanisms, their role with the clinician, and provide clinical scenarios to highlight the various points at which biases may emerge. We discuss strategies to modify the development and influence of these processes and the vulnerability of heuristics to provide insight and improve clinical outcomes.
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Chemical agents that target the eyes have been a popular choice for law enforcement during riots and for military training for nearly a century. The most commonly used agents are chloroacetophenone (formerly sold as Mace), o-chlorobenzylidene malononitrile, and oleoresin capsicum (OC or pepper spray, current ingredient for Mace). Initially, most severe ocular injuries were caused by the explosive force rather than the chemical itself. ⋯ The effects on eyes include conjunctival injection, complete corneal epithelial defects, pseudopterygium, corneal neovascularization, persistent conjunctivalization, corneal opacities, and reduced visual acuity. Current management, based on limited human studies, emphasizes decontamination and symptomatic treatment. We review the literature related to clinical and histopathologic effects of tear gas agents on the eye and their management.
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Survey of ophthalmology · Mar 2016
ReviewManaging juvenile idiopathic arthritis-associated uveitis.
Bilateral chronic anterior uveitis is an extra-articular feature of juvenile idiopathic arthritis. Although figures vary, uveitis occurs in approximately 11%-13% of patients with this disease and is most commonly associated with the female gender, oligoarthritis, and presence of antinuclear antibodies. The disease has an insidious onset and is often asymptomatic. ⋯ Small scale studies and practice have provided the evidence to undertake randomized control trials to evaluate the efficacy, safety, and cost-effectiveness of anti-tumor necrosis factor-α therapies, such as infliximab and adalimumab. These have demonstrated promising results, with further data awaited from ongoing trials for adalimumab (as SYCAMORE and ADJUVITE trials). Lower grade evidence is supporting the use of newer biologics such as rituximab, daclizumab, tocilizumab, and abatacept in those cases refractory to anti-tumor necrosis factor-α therapy.
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A well-focused operating microscope addresses several needs that are all secondary to the surgeon's need to see clearly at all times. These needs include: the assistant; the sharpness of the video and monitor; as well as field of view, asthenopia, and focusing issues related to zoom, accommodation, and presbyopia. We provide a practical approach to achieve optimal focus that we call the sloping paper calibration method.
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Survey of ophthalmology · May 2015
ReviewFactors associated with postoperative pain and analgesic consumption in ophthalmic surgery: a systematic review.
Pain in ophthalmic surgery is a neglected area. We systematically reviewed the factors associated with postoperative pain and analgesic consumption in ophthalmic surgery and found 12 studies with 1,515 participants. The median number of patients in the included studies was 59. ⋯ Type of surgery, type of anesthesia, and patient satisfaction with anesthesia were associated with increased analgesic consumption. The studies reviewed were heterogeneous in terms of surgical procedures, patient populations, tools for pain assessment, and timing of postoperative pain measurement. Multiple factors may be associated with increased postoperative pain and analgesic consumption and warrant further research.