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Objective: To assess the impact of digital problem-based learning (PBL) cases on student learning in ophthalmology courses. Methods: Ninety students were randomly divided into 3 classes (30 students per class). The first class studied under a didactic model. The other 2 classes were divided into 6 groups (10 students per group) and received PBL teaching; 3 groups studied via cases presented in digital form and the others studied via paper-form cases. The results of theoretical and case analysis examinations were analyzed using the χ2 test. Student performance on the interval practice was analyzed using the Kruskal-Wallis test. Questionnaires were used to evaluate student and facilitator perceptions. Results: Students in the digital groups exhibited better performance in the practice procedures according to tutorial evaluations compared with the other groups (P<.05). The 2 PBL classes had significantly higher mean results of theoretical and case analysis examinations (P<.001), but there was no significant difference between the 2 PBL classes. Ninety-three percent of students in the digital groups (vs 73% in the paper groups) noted that the cases greatly stimulated their interest. Conclusions: Introducing PBL into ophthalmology could improve educational quality and effectiveness. Digital PBL cases stimulate interest and motivate students to further improve diagnosis and problem-handling skills. [ABSTRACT FROM AUTHOR]

Objective: To evaluate documentation of physician evaluations of patients with dry eye for the presence of key elements as defined in the American Academy ofOphthalmology Summary Benchmarks for Preferred Practice Patterns. Methods: One hundred thirty-one medical records of patients seen at the Duke Eye Center from January 1998 to July 2008 were reviewed relative to both the dry eye preferred practice patterns benchmarks for 1998 (all patients) and 2003 (for those seen between 2004 and 2008). Overall total score and subsection scores were calculated for all patients, as well as by specialty provider types and by type of medical record (electronic vs paper). Results: Of all records reviewed, 84.8% were for women and the mean (SD) age of all patients was 60.3 (20.8) years. On average, 66.4% of the initial history key elements, 77.3% of the initial physical examination key elements, 40.0% of care management key elements, and 67.9% of patient education key elements were documented. The physical examination scores were highest in the "other" subspecialty ophthalmologist group compared with the comprehensive ophthalmologist group (P=.03) and cornea specialists (P=.02). The physical examination scores were 87% in the electronic medical record and 75% in the standard paper medical record (P<.001) groups. Conclusions: In an academic practice, the process of care delivery for dry eye does conform to the American Academy of Ophthalmology Preferred Practice Patterns in some areas; however, there is room for improvement especially in the areas of patient education and care management. Additional data are needed from other practice settings to further evaluate the quality of dry eye care. [ABSTRACT FROM AUTHOR]

Objective: To describe grading procedures for optical coherence tomographic (OCT) images of participants in the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study. Methods: Optical coherence tomograms were taken at clinical sites with the Stratus OCT using fast macular and crosshair scan protocols. Paper prints of images were evaluated at a central reading center. Quality evaluation identified the accuracy of OCT-measured retinal thickness data and was categorized as good, fair, borderline, or ungradable. Manual measurement of center point thickness was performed on borderline images. Morphological evaluation identified cystoid spaces, subretinal fluid, and vitreoretinal interface abnormalities. Reproducibility of grading was assessed through formal quality control exercises. Results: A randomly selected set of 106 images was identified for quality control. The first 2 annual regrades showed 91% and 89% intergrader agreement for OCT quality. Intraclass correlation for manually measured center point thickness was 0.99 per year. For morphological variables, intergrader agreement for cystoid spaces was 83% and 76%. Reproducibility for subretinal fluid and vitreoretinal interface abnormalities could not be interpreted owing to their limited presence in the sample. Conclusion: Optical coherence tomogram evaluation procedures used in the SCORE Study are reproducible and can be used for multicenter longitudinal studies of retinal vein occlusion. [ABSTRACT FROM AUTHOR]

A talented young scientist, Thomas Harriot, wrote the first English account of the New World, "A Briefe and True Report of the New Found Land of Virginia," distinguished by its serious effort to describe and understand the American Indian. Harriot went on to make innovations in mathematics and was one of the first astronomers to use the telescope. His largely unappreciated contribution to the history of ophthalmology was the first formulation of the sine law of refraction of light, found in his unpublished papers long after his death in 1621. Willebrord Snell discovered the sine law in Holland in 1621 but also died without formally publishing it. René Descartes first published the sine law in 1637. The sine law of refraction became not only the prime law of all lens systems but ushered in a new world of physical laws. [ABSTRACT FROM AUTHOR]

Context.—Anxiety about bias, lack of accountability, and poor quality of peer review has led to questions about the imbalance in anonymity between reviewers and authors. Objective.—To evaluate the effect on the quality of peer review of blinding reviewers to the authors' identities and requiring reviewers to sign their reports. Design.—Randomized controlled trial. Setting.—A general medical journal. Participants.—A total of 420 reviewers from the journal's database. Intervention.—We modified a paper accepted for publication introducing 8 areas of weakness. Reviewers were randomly allocated to 5 groups. Groups 1 and 2 received manuscripts from which the authors' names and affiliations had been removed, while groups 3 and 4 were aware of the authors' identities. Groups 1 and 3 were asked to sign their reports, while groups 2 and 4 were asked to return their reports unsigned. The fifth group was sent the paper in the usual manner of the journal, with authors' identities revealed and a request to comment anonymously. Group 5 differed from group 4 only in that its members were unaware that they were taking part in a study. Main Outcome Measure.—The number of weaknesses in the paper that were commented on by the reviewers. Results.—Reports were received from 221 reviewers (53%). The mean number of weaknesses commented on was 2 (1.7, 2.1, 1.8, and 1.9 for groups 1, 2, 3, and 4 and 5 combined, respectively). There were no statistically significant differences between groups in their performance. Reviewers who were blinded to authors' identities were less likely to recommend rejection than those who were aware of the authors' identities (odds ratio, 0.5; 95% confidence interval, 0.3-1.0). Conclusions.—Neither blinding reviewers to the authors and origin of the paper nor requiring them to sign their reports had any effect on rate of detection of errors. Such measures are unlikely to improve the quality of peer review... [ABSTRACT FROM AUTHOR]

Discusses how editors, authors and readers of peer-reviewed journals such as the "Archives of Ophthalmology" can address the doubt and skepticism about the integrity of the process by which new medical and scientific findings are published. Causes for the loss of public confidence in the validity of reported scientific results; Public registration of clinical trials; Ethical responsibilities of editors, authors and readers.

Describes a maneuver in patients with thyroid orbitopathy to reposition a subluxed globe. Instruction for the patient to make contact only on the scleral surface; Angles necessary for the correct changes in position.

Objective: To understand the role of the α1A-adrenoreceptors (ARs) in the pathophysiologic mechanism of intraoperative floppy iris syndrome (IFIS). Methods: Iris specimens from a patient with tamsulosin hydrochloride-induced IFIS were obtained during trabeculectomy. Specimens underwent histological analysis and immunohistochemical analysis with antibodies specific for actin, myoglobin, α1A-ARs, and myosin. Iris specimens from a patient without IFIS were used for comparison. Samples were processed for transmission electron microscopy. Results: Histological examination showed normal dilator muscle, arterioles, stroma, and pigment epithelium. Actin, myosin, and myoglobin distribution and intensities were similar between IFIS and non-IFIS tissue. The staining pattern and colocalization with myosin suggested that α1A-ARs are present in iris arteriolar muscularis in addition to the dilator muscle in both IFIS and control irides. Significantly less staining of IFIS tissue was found compared with the non-IFIS iris. Ultrastructures of melanocytes and stroma appeared to be normal. Iris arterioles possessed thick endothelial basement membranes, semilongitudinally oriented muscularis, and abundant perivascular collagen coats. Conclusions: We confirm the presence of α1A-ARs in human iris by results of immunohistochemical analysis. The α1A-ARs localize to iris arteriolar muscularis in addition to the iris dilator muscle. This localization suggests that IFIS may develop because of iris vascular dysfunction and that iris vasculature may have structural in addition to nutritive functions. [ABSTRACT FROM AUTHOR]

An interesting letter about an important figure in the history of American ophthalmology was recently discovered in the archives of the Duke University School of Medicine, Durham, NC. The letter, dated September 29,1929, is from Dr Julian Deryl Hart (1894-1980) to Dr Wilbert Cornell Davison (1897-1972).1 In the letter, Hart discusses plans for the new Duke University School of Medicine. Midway through the letter, Hart writes, [ABSTRACT FROM AUTHOR]

Focuses on members of three generations of U.S.-based Knapp family who have achieved national and international prominence in the field of ophthalmology. Herman Jacob Knapp's arrival in the United States in 1868 to become one of America’s most famous and respected ophthalmologists; Foundation of the Archives of Ophthalmology and the New York Ophthalmic and Aural Institute in New York; Establishment of the first specialty section of the American Medical Association; Arnold Herman Knapp's role as editor of the "Archives of Ophthalmology" and a professor of ophthalmology at Columbia University College of Physicians and Surgeons in New York City; Recognition of Arnold as one of the foremost ophthalmologists of the first half of the 20th century; Philip Knapp, the third generation and the only U.S.-trained member of the family who was a clinical professor of ophthalmology at Columbia University College of Physicians and Surgeons; Recognition of Philip for his contributions in the field of ocular motility.

Samuel Pepys (1633-1703) is known for writing the finest diary in the English language. He was a man of remarkable accomplishments who transformed the English Navy, was president of the Royal Society, and was a member of the British Parliament. He survived the Great Plague and imprisonment in the Tower of London. During the years when he was writing the diary, Pepys began to experience great pain in his eyes when reading and writing and from photophobia, which caused him to give up writing the diary. Pepys also had an ultimately unjustifiable fear of blindness. [ABSTRACT FROM AUTHOR]

Editorial. Focuses on the practice of ophthalmology in Spain. Estimate number of ophthalmologists in the country; Conditions and characteristics of clinical ophthalmology practice; Biomedical research; Training in ophthalmology.

In this era of ever-increasing printed and electronic publications, we often take for granted the accuracy of the information provided. As the meaning of the presentation is debated, we assume that the data on which we base our judgment have been honestly and accurately developed. Occasionally, it is wise to remember that editorial lapses may lead to false conclusions, as the following story will illustrate. [ABSTRACT FROM AUTHOR]

This article gives the guidelines for paper submission. The "Journal of the American Medical Association (JAMA)" and the "Archives of Ophthalmology" function as an editorial consortium. With one submission and one set of reviews, the clinical trial manuscript will be considered for publication in both JAMA and the "Archives of Ophthalmology." The paper should be submitted to the journal of choice according to the appropriate "Instructions for Authors." If the submission is accepted by JAMA, it will be considered for an editorial or commentary in JAMA.

Presents a response by William C. Stewart and the ISV-205 Study Group to a letter to the editor about their article "Prevention of Corticosteroid-Induced in Intraocular Pressure Elevation Using ISV-205," in the November 2003 issue of "Archives of Ophthalmology."

Editorial. Discusses different ophthalmology journals, their history and the editorship of the 'American Journal of Ophthalmology,' by Bradley R. Straatsma and Donald Minckler. Details on the comprehensive article written by ophthalmic editor Edward Jackson on the history of ophthalmic literature; Information on the first ophthalmology journals; Affect of leadership of Straatsma on ophthalmic organizations.

Editorial. Comments on the implications of genetic analysis in Leber congenital amaurosis (LCA). Novel mutations causing a subset of LCA; Overview of the conditions; Genetic screening for LCA.

Presents letters received by the editors of the 'Archives of Ophthalmology,' that comments on papers published. Pain control after orbital implant surgery; Legal problems arising out of laser misuse.

Editorial. Comments on the need for more research papers on innovative surgical procedures for treating melanoma. Recognition of the increased risk of developing an infected bleb; Reasons for the ambivalence toward performing filtration surgery.

Examines the state of clinical eye research in the U.S. Potential for flaws in ophthalmic research; Efforts to minimize errors in ophthalmology articles; Peer review in eye research; Role of the journal 'Archives of Ophthalmology' in eye research.

Comments on inquiries related to the care of ophthalmology patients. Creation of laser-induced chorioretinal anastomosis in retinal vein occlusions; Extension of investigations on reflex lacrimations in neonates; Improvement of visual acuity in patients.

Presents an exchange of views on ophthalmology-related papers previously published in the periodical 'Archives of Ophthalmology.' Intermittent exotropia; Pregnancy-associated overcorrection following myopic excimer laser photorefractive keratectomy.

Objective: To compare the cost-effectiveness of 2 approaches for treating unilateral nasolacrimal duct obstruction (NLDO). Methods: One hundred sixty-three infants aged 6 to less than 10 months with unilateral NLDO were randomly assigned to receive immediate office-based nasolacrimal duct probing (n = 82) or 6 months of observation/nonsurgical management (n=81) followed by probing in a facility for persistent symptoms. Main Outcome Measures: Treatment success was defined as the absence of clinical signs of NLDO (epiphora, increased tear lake, mucous discharge) on masked examination at age 18 months. Cost of treatment between randomization and age 18 months included costs for all surgical procedures and medications. Results: In the observation/deferred facility-probing group, NLDO resolved within 6 months without surgery in 44 of the 67 patients (66%; 95% CI,54% to 76%) who completed the 6-month visit. Twenty-two (27%) of the 81 patients in the observation/deferred facility-probing group underwent surgery, 4 of whom were operated on within the initial 6 months. At age 18 months, 69 of 75 patients (92%) in the immediate office-probing group were treatment successes, compared with 58 of 71 observation/deferred facility-probing group patients (82%) (10% difference in success;95% CI,-1% to 21%). The mean cost of treatment was $562 in the immediate office-probing group compared with $701 in the observation/ deferred facility-probing group (difference,-$139; 95% CI, -$377 to $94). The immediate office-probing group experienced 3.0 fewer months of symptoms (95% CI, -1.8 to -4.0). Conclusions: The immediate office-probing approach is likely more cost-effective than observation followed by deferred facility probing if needed. Adoption of the immediate office-probing approach would result in probing in approximately two-thirds of infants whose obstruction would have resolved within 6 months of nonsurgical management, but would largely avoid the need for probing under general anesthesia. Application to Clinical Practice: Although unilateral NLDO often resolves without surgery, immediate office probing is an effective and potentially cost-saving treatment option. [ABSTRACT FROM AUTHOR]

Objective: To compare the safety and efficacy of limbal-conjunctival vs conjunctival autograft transplant for treating recurrent pterygia. Methods: In a randomized, prospective, parallel-group clinical trial, 224 patients with advanced recurrent pterygia underwent free conjunctival autograft transplant (112 eyes) or limbal-conjunctival autograft transplant (112 eyes). Two hundred five patients completed the follow-up (100 eyes from the conjunctival autograft group and 105 eyes from the limbal-conjunctival autograft group). Main Outcome Measures: Recurrence of pterygium, with complications as the secondary outcome measure (ie, signs of limbal stem cell deficiency). Results: With a mean follow-up of 62 (range, 36-96) months, 10 patients (10.0%) in the conjunctival autograft group and 1 patient (1.0%) in the limbal-conjunctival autograft group developed recurrence. No signs of limbal stem cell deficiency were observed during follow-up. Conclusion: Limbal-conjunctival transplant is safe and more effective than free conjunctival transplant in preventing recurrence after excision of recurrent pterygia (P=.004). Application to Clinical Practice: Limbal-conjunctival autografts could be a favored option for managing advanced recurrent pterygia in young high-risk patients. [ABSTRACT FROM AUTHOR]

Objective: To characterize the phenotype of a white patient with occult macular dystrophy (OMD) and her clinically unaffected family members and to determine whether similar mutations were present in the RP1L1 gene in this family. Occult macular dystrophy is a rare macular dystrophy with central cone dysfunction hidden behind a normal fundus appearance that has been attributed to a mutation in the retinitis pigmentosa 1-like 1 (RP1L1) gene in 4 Japanese families. Methods: In this observational cross-sectional study of 1 white family with OMD, patients meeting the clinical criteria for OMD and their family members were evaluated by use of multifocal electroretinography, the Farnsworth D-15 color vision test, automated perimetry, spectral- domain optical coherence tomography (SD-OCT), fundus autofluorescence, and fundus photography. Fluorescein angiography was performed only on the proband. Members of this family were screened for genetic mutations in the RP1L1 gene. Results: In the family studied, the clinically affected proband was noted to have loss of the foveal outer segments and absence of bowing of the inner segment/ outer segment junction on SD-OCT scans. In addition, 1 clinically unaffected family member also demonstrated loss of the foveal photoreceptor outer segments and, therefore, decreased bowing of the inner segment/outer segment junction on SD-OCT scans. The fundus autofluorescence images of the eyes of the proband and her family members were normal. Although mutations in the RP1L1 gene have been identified in sporadic and autosomal dominant OMD pedigrees, no mutations in the RP1L1 gene were found in any of the participants. Conclusions: Loss of the outer segments of foveal photoreceptors can be detected and quantified by use of SDOCT in patients with OMD. Similar findings are present in some clinically unaffected family members and may represent subclinical manifestations of the disease. Although mutations in the RP1L1 gene have been described in several Japanese families with OMD, there were no such mutations in this white family of European descent, which suggests that inherited OMD is a genetically heterogeneous disorder. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the balance between the sexes of published ophthalmic material at the editorial, reviewer, and author levels. Design: Cross-sectional study of 3 journals, American Journal of Ophthalmology, Archives of Ophthalmology, and Ophthalmology, for 1969, 1979, 1989, 1999, and 2009. The data were compared with ophthalmologist-in-training and physician profile in major contributing states from North America and Europe during the same period. Results: Of the 3 major ophthalmology journals, none had a female editor-in-chief. For all journals, the proportion of editorial board members who were women increased from 3.3% in 1969 to 18.8% in 2009. For all journals and all years, women composed a higher proportion of first authors (29.2% in 2009) compared with senior authors (22.9% in 2009), reviewers (18.9% in 2009), or assistant editors (12.5% in 2009). There was an abrupt shift toward women after 1989 in first authorship in Ophthalmology (1969, 4.6%; 1979, 5.4%; 1989, 12.3%; and 1999, 20.2%), Archives of Ophthalmology (1969, 6.6%; 1979, 5.1%; 1989, 15.6%; and 1999, 28.6%), and American Journal of Ophthalmology (1969, 5.6%; 1979, 4.2%; 1989, 9.2%; and 1999, 23.9%). There was also an abrupt increase in female senior authorship for American Journal of Ophthalmology after 1989 (1979, 8.5%; 1989, 8.1%; and 1999, 18.3%). The increase in female first authorship during the 5 decades was parallel with the increase in US female physicians. Conclusions:Womenophthalmologists are authoring publications in increasing numbers that match their prevalence in the academic and overall workforce. However, all editors are men. This discrepancy relates to the relatively younger generation of female ophthalmologists or selection bias, a subject that requires further investigation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and complications of intravitreal chemotherapy for viable vitreous seeding from retinoblastoma. Methods: Intravitreal injection of melphalan (8-50 μg in 0.05 mL) followed by injection site cryotherapy. Results: Among 12 treated cases, success with control of vitreous seeds was achieved in 10 of 12 cases at immediate follow-up (0-3 months), 8 of 10 cases at shortterm follow-up (3-6 months), and 6 of 10 cases at longterm (>6 months) follow-up. Among those 8 cases that received an 8- to 10-μg dose, control was achieved in 6 of 8 cases at immediate follow-up, 5 of 7 cases at shortterm follow-up, and 3 of 7 cases at long-term follow-up. Complications with the 8- to 10-μg dose were minor and included preretinal hemorrhage and retinal vasculitis with retinal pigment epithelial alterations. Of those 4 that received a 50-μg dose, immediate, short-term, and long-term control was 100%, but complications of cataract, vitreous hemorrhage, subretinal hemorrhage, severe hypotonia, and phthisis lead to enucleation in 2 cases. There was no case of orbital tumor recurrence or retinoblastoma metastasis (follow-up range, 8-66 months). Conclusions: Intravitreal melphalan for recurrent vitreous seeds from retinoblastoma appears to provide vitreous seed control in some patients. A high dose (50 μg) of melphalan is toxic and should be avoided. [ABSTRACT FROM AUTHOR]