Elliott Yann Ah-kee

A review of drug-induced acute angle closure glaucoma for non-ophthalmologists

Acute angle closure glaucoma is an ophthalmic emergency and can lead to blindness if left untreated. Several types of drugs have the potential to precipitate acute angle closure glaucoma. These include adrenergic, cholinergic and anticholinergic, antidepressants, anticoagulants and sulfa-based agents. This article provides a basic overview of the risk factors and pathophysiologic mechanisms involved in angle closure glaucoma and focuses on drug-induced angle closure glaucoma for the non-ophthalmologist. A PubMed search limited to the English language was conducted to find relevant literature for the purpose of this article. Most attacks occur in subjects unaware that they are at risk due to innately narrow iridocorneal angles. Clinicians should always review medications in patients presenting with symptoms of acute angle closure glaucoma. The aim of this article is to bring this ophthalmic condition to the attention of clinicians, particularly those outside the field of ophthalmology who commonly prescribe these medications or see these patients prior to referring to ophthalmologists.

Impact of Parental History of Myopia on the Development of Myopia in Mainland China School-Aged Children

Background Myopia is a very common condition and a significant public health problem in China. The objective of the study was to explore the genetic influence on myopia in Mainland China school-aged children in Beijing. Methods In 2008, the data from 15,316 Chinese school students aged 6–18 years from 19 randomized schools in Beijing were analyzed to evaluate genetic influence on myopia in children. Heritability was calculated by mid-parent–offspring regression and parent–offspring regression. Results The estimate of heritability was 0.30 (95% CI, 0.27–0.33) for refractive value (RV). The adjusted mean refractive error was –2.33D (95% CI, –2.45 to –2.21) in children with two myopic parents compared with –1.13D (95% CI, –1.78 to –1.08) in children with no parental myopia. The adjusted odds ratio (OR) was 2.83 (95% CI, 2.47–3.24) in children with two myopic parents compared with no parental myopia. Conclusion The study found a strong association between parental history of myopia and genesis of myopia in the offspring even after adjusting for environmental factors.

Macular optical coherence tomography findings following blunt ocular trauma

This case report describes the optical coherence tomography (OCT) results of Berlin’s edema in a male subject following blunt ocular trauma from a soccer ball. A 27-year-old male presented with blurred vision in his left eye following blunt trauma. On admission, he underwent a complete eye examination and an OCT of the macula. Fundoscopy revealed commotio retinae, observed as an abnormal cream-colored discoloration of the fovea. The OCT showed outer photoreceptor segment disruption, retinal pigment epithelium inter-digitation, and intra-retinal edema of the outer nuclear layer. Following initial management, a repeat OCT after 3 months showed near complete resolution. OCT can be a useful adjunct for monitoring the progress of Berlin’s edema secondary to blunt ocular trauma because Berlin’s edema may present similarly clinically to other ocular trauma, but can affect different layers of the retina depending on the type of injury to the eye.

Advances in the management of diabetic macular oedema based on evidence from the Diabetic Retinopathy Clinical Research Network.

The Diabetic Retinopathy Clinical Research Network (DRCR.net) performs studies on new treatments for diabetic retinopathy. This review aims to summarise recent findings from DRCR.net studies on the treatment of diabetic macular oedema. We performed a PubMed search of articles from the DRCR.net, which included all studies pertaining to the treatment of diabetic maculopathy. The main outcome measures were retinal thickening as assessed by central subfield thickness on optical coherence tomography and improvement of visual acuity on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Findings from each study were divided into modalities of treatment, namely photocoagulation, bevacizumab, triamcinolone, ranibizumab and vitrectomy. While modified ETDRS focal/grid laser remains the standard of care, intravitreal corticosteroids or anti-vascular endothelial growth factor agents have also proven to be effective, although they come with associated side effects. The choice of treatment modality for diabetic macular oedema is a clinical judgement call, and depends on the patients clinical history and assessment.

How can undergraduate ophthalmology teaching be improved

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Advances in Medical Education and Practice 2015:6 469–470 Advances in Medical Education and Practice Dovepress

Incorporating medical leadership and management into the UK undergraduate medical curriculum

Dear editor We read with high interest the letter by Singh et al1 which advocates a mandatory year studying for a BSc in management, within the UK undergraduate medical curriculum. The authors have supported their proposition with compelling figures from a recent National Health Service (NHS) report, which is expecting a £30 billion funding gap by 2020/2021. We strongly believe that nowadays, leadership and management skills are crucial within the NHS and have been shown to positively impact the overall performance of doctors appointed to hospital boards of directors and clinical outcomes.2 Furthermore, we agree with the authors that a lack of knowledge of the NHS structure can be efficiently addressed by incorporating medical leadership and management (MLM) early during undergraduate training. However, we believe that a mandatory year studying management within an already overcrowded undergraduate curriculum is not realistic and feasible. Moreover, several identified barriers to the implementation of such education, including negative attitudes held by both doctors and students toward MLM still need to be addressed.2 Different teaching initiatives have previously been implemented with varying degrees of success, but MLM education still lacks consistency and current literature on how to incorporate this into the undergraduate curriculum, is scarce.3 In a recent national survey of UK medical school faculties and students, Stringfellow et al3 reported that over 70% valued the importance of MLM within the curriculum, hence creating a foundation for education. In addition, the study investigated potential methods of teaching and assessment that could be used for MLM incorporation in undergraduate training. Preferred methods included experiential learning or simulation, quality improvement projects, and student audits. The study concluded that curriculum changes could be achieved by devising new competencies for future editions of General Medical Council’s “Tomorrow’s Doctors”. This could require input from professional bodies, including the General Medical Council, Faculty of Medical Leadership and Management, and NHS Leadership Academy. In conclusion, we would also like to highlight the importance of MLM within the UK undergraduate medical curriculum. However, further work is required to implement a nationally cohesive MLM program that is evidence-based, in UK medical schools.

Simulated eye surgery: The future of ophthalmology training?

ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20 Simulated eye surgery: The future of ophthalmology training? Elliott Yann Ah-kee & Lik Thai Lim To cite this article: Elliott Yann Ah-kee & Lik Thai Lim (2015): Simulated eye surgery: The future of ophthalmology training?, Medical Teacher, DOI: 10.3109/0142159X.2015.1066767 To link to this article: http://dx.doi.org/10.3109/0142159X.2015.1066767

Value of undergraduate ophthalmology attachment

We read the article by Schulz and Hodgkins with interest, and believe that it raised important issues surrounding undergraduate ophthalmology teaching in the UK. 1 Findings from the survey suggest that fi nalyear medical students lack confi dence in their ability to use the direct ophthalmoscope and to recognise pathology. The authors made recommendations, including formal instruction for students, increased clinical exposure, and the provision of assessment and feedback on technique.

The effect of socio-economic status on severity of periocular basal cell carcinoma at presentation

Purpose: To evaluate the influence of socio-economic factors on size of periocular basal cell carcinoma at presentation. Methods: All periocular basal cell carcinoma cases receiving treatment from the oculoplastics team in South Glasgow Hospitals NHS Trust, Glasgow, between 1999 and 2009, were identified retrospectively. Information collected included demographic details of patients, side and site of lesions, type of lesions, and size of lesions. The size of lesion was defined as small for any dimension not exceeding 5 mm, medium for dimensions between 6 mm and 10 mm, and large for dimensions exceeding 11 mm. Home address was used to determine the Scottish Index of Multiple Deprivation rank. The demographics, size of lesion, and Scottish Index of Multiple Deprivation rank were investigated using the general linear regression modelling. Results: Of the 67 cases, 24 were men and 43 were women. The mean age was 71.5 years. There were a total of 67 identified cases, of which 38 presented with small-size lesions, 24 with medium-size lesions, and 5 with large-size lesions. Scottish Index of Multiple Deprivation is related to the presenting incidence of basal cell carcinoma, with the lower ranks presenting more frequently. Conclusions: Socio-economic deprivation is associated with larger and more frequent presentation of periocular basal cell carcinoma. This highlights the importance of raising awareness among populations of the more deprived areas of the significance of lumps and bumps within the periocular regions.

The use of smartphones by junior doctors

No abstract available. (Published: 2 June 2015) Citation: Med Educ Online 2015, 20: 28189 - http://dx.doi.org/10.3402/meo.v20.28189