Purpose: To connect didactic learning to clinical application is a challenging task both for the teachers and students. Target-Oriented Clinical Skill Enhancement (TOCSE) is a teaching and learning tool that integrates basic medical sciences at the clinical level. The authors sought to determine if TOCSE is effective in bridging didactic knowledge to clinical skill and enhancing the clinical performance of fourth year medical students.

Method: Between March 2021 and June 2021, in an online platform, the authors randomly allocated 141 fourth year medical students into the experimental (n=12 groups; n=63) and control groups (n=12 groups; n=78). Participants in the experimental group underwent the TOCSE module workshop while the control group utilized the standard method of teaching. The actively teaching faculty staff blinded of group allocation were invited to assess case presentations using a standardized rubric. A survey was done by the students (experimental and control) to evaluate how they perceived TOCSE to their performance and learning. Independent parametric t-test was performed to compare the clinical skill scores between the two groups.

Results: The experimental group had a mean clinical skill score of 35.29 (SD=2.64, excellent) while the control group had a mean clinical skill score of 31.96 (SD=4.04, satisfactory). The between-group comparisons using independent t-test indicated that the mean difference of -3.33 clinical skills scores between the experimental and control groups was statistically significant (t=-2.39, p=0.026, 95% CI=-6.22 to -0.45). Moreover, the perceived usefulness score (scale 10 as highest) among the TOCSE presenters (experimental groups) was 8.43 (SD=0.84) and scores among the TOCSE audience (control groups) was comparable at 8.36 (SD=0.71), both of which were interpreted as very helpful.

Conclusion: TOCSE is effective in bridging didactic knowledge to clinical skill and enhancing clinical performance of fourth year medical students.

Astigmatism ; Coma ; Corneal Topography ; Corneal Wavefront Aberration ; Humans ; Linear Models ; Lotus ; Myopia ; Refractive Surgical Procedures ; Retrospective Studies ; Visual Acuity

PURPOSE: We used a questionnaire to explore perceptions and clinical practice patterns of Korean pediatric ophthalmologists in terms of amblyopia.METHODS: From September to November 2018, we conducted a web-based questionnaire survey of 99 specialists of the Korean Association for Pediatric Ophthalmology and Strabismus who operated ophthalmology clinics in Korea. We received 56 responses (56.57%) and retrospectively analyzed the data.RESULTS: The average specialist age was 44.0 ± 9.7 years. The mean age of treated amblyopia patients was 3 to 5 years (69.6%); the most common amblyopia was refractive anisometropic amblyopia (75.0%). On average, treatment commenced at 4 years of age (53.6%); child and parent co-operation most significantly influenced treatment success (46.4%). The preferred test was cycloplegic refraction (96.4%) and the preferred treatment occlusion therapy (100%) with glasses correction (98.2%). Occlusion therapy was most commonly performed for 2 hours/day (69.6%); the minimum age for eyeglasses prescription was 2.10 ± 1.18 years. Only three respondents (5.36%) prescribed contact lenses and only one (1.79%) performed refractive surgery.CONCLUSIONS: In Korea, amblyopia treatment is based on occlusion therapy and glasses correction. However, the time of treatment commencement, the duration of occlusion therapy, and the glasses used for correction varied. It is necessary to develop guidelines for amblyopia treatment; these should reflect current medical conditions.
Amblyopia ; Child ; Contact Lenses ; Eyeglasses ; Glass ; Humans ; Korea ; Ophthalmology ; Parents ; Practice Patterns, Physicians' ; Prescriptions ; Refractive Surgical Procedures ; Retrospective Studies ; Specialization ; Strabismus ; Surveys and Questionnaires

Laser corneal refractive surgery has become an important treatment to correct ametropia in recent years. Rational medication in the perioperative period is essential to ensure the success of the surgery and to reduce complications. However, in this area there has been no consistent understanding and unified application guide across the world. Experts in Refractive Surgery Group, Ocular Microcirculation Branch of Chinese Society of Microcirculation who are specialized in keratology and optometry had initiated extensive and rigorous discussions and reached a consensus on appropriate medication before, during and after the refractive surgeries. The consensus covers a broad spectrum of commonly used ophthalmic solutions, provides recommendations of routine and enhanced medication on prevention and management of adverse reactions and complications related to the laser corneal refractive surgeries. We hope the consensus serves as a standard perioperative medication regimen for ophthalmologists, helps to ensure the safety and effectiveness of laser corneal refractive surgeries, and improves the quality and outcome of the refractive surgeries.
Anti-Bacterial Agents/therapeutic use* ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use* ; Asian People/statistics & numerical data* ; China ; Consensus ; Cornea/surgery* ; Drug Therapy/methods* ; Expert Testimony ; Glucocorticoids/therapeutic use* ; Humans ; Lasers ; Ophthalmic Solutions/therapeutic use* ; Perioperative Care ; Refractive Errors/therapy* ; Refractive Surgical Procedures/methods*

Presbyopia is an age-related condition that progressively decreases the ability to focus on near objects. Minimally invasive surgical techniques have been developed to improve near vision, including laser in situ keratomileuses (LASIK) and corneal inlay. Most have similar approaches using monovision or increasing the depth of focus. Monovision laser refractive surgery is a combination of conventional LASIK, LASIK which creates a multifocal cornea (central near or peripheral near) and aspheric micro-monovision LASIK with a special ablation profile, which develops spherical aberration. Conductive keratoplasty is a method that uses radiofrequency energy to shrink the mid-peripheral corneal stromal tissue. However, it is not used because of regression. A corneal inlay is a small device that is implanted in the corneal flap or pocket made by a femtosecond laser. It is inserted into the non-dominant eye. There are various inlays such as the Flexivue Microlens (refractive), Raindrop (corneal shape-changing), and KAMRA (small-aperture) inlays. However, the safety and effectiveness of these inlays have not been proven over a long follow-up period, so care is required when performing inlay implantation. All presbyopia treatments can improve near vision but also have limitations and side effects such as reduced far vision, contrast sensitivity, or increased glare. Therefore, it is essential to select patients carefully. Mechanisms associated with presbyopia are not fully understood, and presbyopia remains challenging for ophthalmologists.
Contrast Sensitivity ; Cornea ; Corneal Transplantation ; Follow-Up Studies ; Glare ; Humans ; Inlays ; Keratomileusis, Laser In Situ ; Methods ; Presbyopia ; Refractive Surgical Procedures ; Vision, Monocular

PURPOSE: We report a case of homonymous quadrantanopia caused by occipital lobe ulegyria. CASE SUMMARY: A 23-year-female was referred to our clinic because of a visual field defect incidentally discovered during preoperative evaluation for refractive surgery at another clinic. However, she did not report any symptoms. She had no systemic diseases. Visual acuity was 20/20 in both eyes, and the color vision test was normal. Both pupils exhibited normal responses to light and near stimulations. In fundus examinations, the right optic disc was normal and the left contained drusen. Automated perimetry revealed right lower homonymous quadrantanopia with macular sparing. Brain magnetic resonance imaging revealed areas of ulegyria involving the left occipital lobe, consistent with the visual field defect. A follow-up visual field test performed 5 months later yielded the same result. CONCLUSIONS: Neuroimaging should be performed in patients with homonymous visual field defects to determine the location and etiology of the brain lesions. Occipital lobe ulegyria can cause homonymous quadrantanopia in the absence of any neurological problem.
Brain ; Brain Injuries ; Color Vision ; Follow-Up Studies ; Hemianopsia ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Occipital Lobe ; Pupil ; Refractive Surgical Procedures ; Visual Acuity ; Visual Field Tests ; Visual Fields

PURPOSE: To investigate the clinical effects of different orientation and magnitude of cyclotorsion on the compensation capacity of the WaveLight EX500 photorefractive keratectomy (PRK) platform. METHODS: This retrospective study comprised 400 eyes of 200 patients who underwent bilateral simultaneous PRK due to compound myopic astigmatism. The subjects were separated according to the orientation of cyclotorsion into incyclotorsion and excyclotorsion groups, and by the magnitude of cyclotorsion into group 1 (0.50 to 2.50 degrees), group 2 (3.00 to 5.00 degrees), group 3 (5.50 to 7.50 degrees), and group 4 (8.00 to 9.50 degrees). RESULTS: The mean magnitude of cyclotorsion was 3.50 ± 2.4 degrees (0.50 to 9.50 degrees) in the incyclotorsion group and 3.32 ± 2.3 degrees (0.50 to 9.50 degrees) in the excyclotorsion group (p = 0.617). The postoperative refractive outcomes of the incyclotorsion and excyclotorsion groups were similar (p > 0.05 for all). The postoperative mean cylindrical refractive error was −0.32 ± 0.3 diopters (D, −1.25 to 0.00 D) in group 1, −0.47 ± 0.2 D (−2.00 to 0.00 D) in group 2, −0.62 ± 0.2 D (−1.00 to −0.25 D) in group 3, and −0.91 ± 0.2 D (−1.50 to −0.50 D) in group 4 (p < 0.001). Preoperative cylindrical refractive error was positively correlated with magnitude of cyclotorsion (r = 0.125 and p = 0.013), which was also positively correlated with postoperative cylindrical refractive error (r = 0.600 and p < 0.001). CONCLUSIONS: Incyclotorsion and excyclotorsion can be equally compensable in the WaveLight EX500 PRK platform for compound myopic astigmatism. A value of ≤2.50 degrees cyclotorsion magnitude was observed to be more compensable than higher degrees of cyclotorsion magnitude. Preoperative high astigmatism was associated with high cyclotorsion magnitude, which was also associated with a high degree of postoperative astigmatism.
Astigmatism ; Compensation and Redress ; Humans ; Myopia ; Photorefractive Keratectomy ; Refractive Errors ; Refractive Surgical Procedures ; Retrospective Studies

PURPOSE: To describe current cataract surgery practice patterns and changing trends among Korean ophthalmologists. METHODS: A survey of members of the Korean Society of Cataract and Refractive Surgery was performed in July 2018. One hundred and two (12.7%) of 801 questionnaires were returned for analysis. The data were analyzed using descriptive statistics and compared with previous surveys. RESULTS: Most of the respondents (75%) had been in practice for 6 or more years and performed an average of 31 cataract surgeries per month. The preferred method for cataract surgery was phacoemulsification (95%); 5% used a femtosecond laser. The use of topical anesthesia markedly increased from 69% (2012) to 80% (2018). The use of optical biometry exceeded that of ultrasound A-scan biometry. A multifocal intraocular lens was used by 76% of the respondents compared with 44% of the respondents in 2012. Topical nonsteroidal anti-inflammatory drugs were used by 70% of the respondents postoperatively. Most (59%) of these anti-inflammatory drugs were prescribed for 4 weeks. CONCLUSIONS: This survey provided a comprehensive update of the present cataract surgery practices in the Republic of Korea. The results emphasized the increasing use of premium intraocular lenses, optical biometry, and topical anesthesia.
Anesthesia ; Biometry ; Cataract ; Lenses, Intraocular ; Methods ; Phacoemulsification ; Refractive Surgical Procedures ; Republic of Korea ; Surveys and Questionnaires ; Ultrasonography

PURPOSE: To evaluate and compare published methods of calculating intraocular lens (IOL) power following myopic laser refractive surgery. METHODS: We performed a retrospective review of the medical records of 69 patients (69 eyes) who had undergone myopic laser refractive surgery previously and subsequently underwent cataract surgery at Samsung Medical Center in Seoul, South Korea from January 2010 to June 2016. None of the patients had pre-refractive surgery biometric data available. The Haigis-L, Shammas, Barrett True-K (no history), Wang-Koch-Maloney, Scheimpflug total corneal refractive power (TCRP) 3 and 4 mm (SRK-T and Haigis), Scheimpflug true net power, and Scheimpflug true refractive power (TRP) 3 mm, 4 mm, and 5 mm (SRK-T and Haigis) methods were employed. IOL power required for target refraction was back-calculated using stable post-cataract surgery manifest refraction, and implanted IOL power and formula accuracy were subsequently compared among calculation methods. RESULTS: Haigis-L, Shammas, Barrett True-K (no history), Wang-Koch-Maloney, Scheimpflug TCRP 4 mm (Haigis), Scheimpflug true net power 4 mm (Haigis), and Scheimpflug TRP 4 mm (Haigis) formulae showed high predictability, with mean arithmetic prediction errors and standard deviations of −0.25 ± 0.59, −0.05 ± 1.19, 0.00 ± 0.88, −0.26 ± 1.17, 0.00 ± 1.09, −0.71 ± 1.20, and 0.03 ± 1.25 diopters, respectively. CONCLUSIONS: Visual outcomes within 1.0 diopter of target refraction were achieved in 85% of eyes using the calculation methods listed above. Haigis-L, Barrett True-K (no history), and Scheimpflug TCRP 4 mm (Haigis) and TRP 4 mm (Haigis) methods showed comparably low prediction errors, despite the absence of historical patient information.
Cataract ; Humans ; Korea ; Lenses, Intraocular* ; Medical Records ; Methods* ; Refractive Surgical Procedures* ; Retrospective Studies ; Seoul

PURPOSE: To analyze the characteristics of medical disputes relating to ophthalmology for prevention in advance. METHODS: Retrospective analyses of ophthalmic cases applied for Korea Medical Dispute Mediation and Arbitration Agency between June 2013 and September 2016. RESULTS: A total of 41 cases were analyzed. The number of cases relating to cataract were 19 (46.3%), refractive surgery 4 (9.8%), anterior segment 4 (9.8%), retina 7 (17.1%), oculoplasty 3 (7.3%), glaucoma 2 (4.9%), and miscellaneous 2 (4.9%). The specialty with the lowest mean payment of mediation per case was cataract (￦3,591,700), which has the largest number of cases, and oculoplasty was the highest mean payment per case (￦21,933,000). There were 16 cases confirmed as negligence by authenticators. Among these 16 cases, 7 (44%) were related to accident during surgery or procedure, 5 cases (31%) were insufficient explanation, and 4 cases (25%) were lack of tests which should have be performed before or after surgery. The results of mediation were agreement in 25 cases (61%), decision made by mediation department in 6 cases (15%), 7 cases were not adequate to mediate (17%), and 3 cases were canceled (7%). CONCLUSIONS: The number of cases associated with cataract was the largest. Among negligence of doctors, cases during surgery were most common, suggesting the need to explain surgical factors such as complications or side effects and the need for complete surgical records. If a medical dispute occurs, the Korea Medical Dispute Mediation and Arbitration Agency can be used to achieve an agreement.
Cataract ; Dissent and Disputes ; Glaucoma ; Korea ; Malpractice ; Negotiating ; Ophthalmology ; Refractive Surgical Procedures ; Retina ; Retrospective Studies