Clinics_and_Practices RSS : Gourt

Permanent Ophthalmology Job in Williamsport Pennsylvania with Susquehanna Health

Susquehanna Health is seeking an Ophthalmologist to join one (1) other in our practice and two (2) others that are in private practice here in Williamsport, Pennsylvania. Be part of the team that is

Permanent Ophthalmology Job in AL statewide Alabama with Medical Doctor Associates, Inc.

Outstanding opportunity for BC/BE Ophthalmologist to join existing practice. Tremendous growth within the community requires recruitment. Excellent financial package with Sign On Bonus. Located in

Permanent Ophthalmology Job in 30 Minutes from Detroit Michigan with Enterprise Medical Service

This is a rapidly growing, progressive, well-established multi-specialty practice with 6 ophthalmologists and 6 optometrists. Their practice includes comprehensive ophthalmology, anterior segment, and

Permanent Ophthalmology Job in West Coast Near Tampa Florida with Enterprise Medical Service

Privately owned single specialty Ophthalmology group practice along western coastal Florida in need of hiring additional Ophthalmologist due to growth. Will be joining 5 MDs, 5 Ods, call 1:5, must be

Permanent Ophthalmology Job in Nashville, TN Tennessee with Enterprise Medical Service

Need Ophthalmologist to join 1 other in Single Specialty practice. General or retina Ophthalmologist is acceptable. Must be boarded for consideration. Competitive salary based on academic ranking and

Permanent Ophthalmology Job in Beautiful Emerald Coast Region of Florida Florida with Enterprise Medical Service

Emerald Coast region of Florida's panhandle in need of full time Ophthalmologist due to patient demand. Hospital will assist in establishing of solo practice with income guarantee, signing bonus, marketing

Permanent Ophthalmology Job in Northeast Texas Texas with Enterprise Medical Service

Northeast Texas community in need of additional Ophthalmologist due to growth. Financial package to include attractive salary, signing bonus, production bonuses, full benefits package including pension

Permanent Ophthalmology Job in South Central Michigan - Surg/Ophth Needed Michigan with Enterprise Medical Service

Well established multi-specialty group in south central Michigan in need of 4th Opththalmologist due to growth. Call 1:4. New Ophthalmologist should be comprehensive and have completed a corneal refractive

Permanent Ophthalmology Job in West Central Arkansas Arkansas with Enterprise Medical Service

Wonderful opportunity to establish a solo Ophthalmology practice with 100% hospital support located just over an hour west of Little Rock, AR with excellent payor mix, 170-bed facility, 5 OR Suites.

Permanent Ophthalmology Job in Northeast Missouri Missouri with Enterprise Medical Service

New state-of-the-art facility in NE Missouri in need of 2nd Ophthalmologist to join newly established program to be located in new medical building under construction for Spring 2008 opening. 100% Hospital

Permanent Ophthalmology Job in Southwest Illinois Need Illinois with Enterprise Medical Service

Solo surgical Ophthalmologist is needed in SW Illinois due to growth. Cases to include: cataracts, lasik, lazer, glaucoma, diabetes. Work mostly out of privately owned outpatient surgery center in Cairo,

Permanent Ophthalmology Job in Southeast Michigan Opportunity Michigan with Enterprise Medical Service

Southeast Michigan single specialty Ophthalmology practice with four clinical locations between Detroit and Toledo in need of fellowship trained cornea or plastics. Seeking surgical Ophthalmologist to

Permanent Ophthalmology Job in Carroll County, MD Opportunity Maryland with Enterprise Medical Service

Hospital in Maryland is seeking an Ophthalmologist to work as employee of hospital. Work in office 4 days/week, see 25-45 patients/day, 1 day/month for consultants and 1 day/week in surgery. Competitive

Permanent Ophthalmology Job in Practice in Vance County, NC North Carolina with Enterprise Medical Service

Bedroom community of Raleigh will be in need of additional Ophthalmologist to practice along side of two well respected physicians in the community. Attractive financial package includes salary, bonuses,

Permanent Ophthalmology Job in Fayetteville, NC North Carolina with Enterprise Medical Service

Private Practice located within 45 minutes of North Carolina's research triangle in need of adding 3rd Ophthalmologist, working in beautiful new clinic situation between two hospitals, traditional practice

Permanent Ophthalmology Job in Gulf Coast Opportunity Florida with Enterprise Medical Service

Seeking an Ophthalmologist for large multi-specialty group. Perform surgery at Ft. Walton Beach Medical Center and Health South Surgery Center. Competitive income with full benefits package that also

Permanent Ophthalmology Job in Northeast Ohio Ohio with Enterprise Medical Service

Single specialty group in NE Ohio needs to replace retiring Ophthalmologist. Call is 1:2. Prefers 2007 resident or with 5 years or less practice experience for early fall start date. Offering an attractive

Permanent Ophthalmology Job in South of Greenville, South Carolina South Carolina with Enterprise Medical Service

Busy 5-person board certified Opthalmology practice needs 6th physician due to growth. Offering competitive salary with 2 year guarantee, plus full benefits including; retirement and relocation with

Locum Tenens Ophthalmology Job in Not Disclosed Texas with

An Ophthalmologist is needed on a locum tenens basis at an Army hospital in El Paso, Texas. The assignment will begin in August and will continue for one year. Board Eligible or Board Certified Ophthalmologist

Permanent Ophthalmology Job in Not Disclosed Michigan with

A rapidly growing, multi-specialty practice with 6 ophthalmologists and 6 optometrists is looking to add more physicians. The practice includes comprehensive ophthalmology, anterior segment and cataract

ABOUT THIS JOURNAL: About This Journal

CLINICAL SCIENCES: Visual Acuity Outcomes Among Sham vs No-Treatment Controls From Randomized Trials

Objective To compare 2-year visual acuity outcomes between similar participants assigned to sham and no-treatment control arms in randomized clinical trials. Methods We retrospectively matched sham controls from 2 randomized trials to no-treatment controls (no sham or placebo) from 3 trials on 8 baseline prognostic criteria (full matches) or on 4 to 7 criteria (partial matches). Outcomes were compared using data from those who had 2-year visual acuity measurements and also using the last observation carried forward method to impute missing 2-year measurements. Results A full match to a no-treatment control was identified for 72 of 321 sham controls (22%); a partial match was identified for another 93 sham controls (29%). Among the fully matched pairs, no important difference in 2-year visual acuity outcomes was observed. However, 2-year outcomes differed somewhat between sham and no-treatment controls within the partially matched pairs. Conclusions Findings from fully matched pairs suggest that sham treatment to mask participants in clinical trials may be unnecessary when visual acuity is the outcome of interest. However, findings from the partially matched pairs do not fully support this conclusion. This analysis challenges the necessity for sham (placebo) controls in randomized clinical trials in ophthalmology when visual acuity is the primary outcome of interest.

FROM THE ARCHIVES OF THE ARCHIVES: 140 Years Ago . . .

CLINICAL SCIENCES: An Objective Evaluation of Eyedrop Instillation in Patients With Glaucoma

Objectives To evaluate the performance of patients with ocular hypertension and glaucoma who are experienced in the instillation of topical ocular hypotensive medications. Methods We conducted a prospective, open-label study at a single private practice site. We enrolled 139 patients with a diagnosis of glaucoma or ocular hypertension who used 1 or more topical ocular hypotensive medications for at least 6 months and who instilled their own medications. Patients were questioned regarding their use of topical ocular hypotensive medications, and we used a video recording to evaluate patient performance of eyedrop instillation with 2 bottle designs. Results Patients reported relatively good performance on eyedrop instillation. One hundred twenty-nine of 139 patients (92.8%) reported no problem putting in their eyedrops, and 86 of 139 (61.9%) believed that they never missed their eye when administering the drops. The proportions of patients who were able to instill a single drop into the eye without touching the bottle to the eye were 14 of 64 (21.9%) with a 15-mL bottle and 36 of 117 (30.8%) with a 2.5-mL bottle. Conclusions Under a single direct observation, patients experienced in the use of topical ocular hypotensive agents performed relatively poorly when instilling a single eyedrop into the eye without touching the bottle tip to the eye or the ocular adnexae. Trial Registration clinicaltrials.gov Identifier: NCT00522600

FROM THE ARCHIVES OF THE ARCHIVES: A look at the past . . .

CLINICAL SCIENCES: Inner Retinal Layer Thinning in Parkinson Disease

Objective To quantify retinal thickness in patients with Parkinson disease (PD). Methods Forty-five eyes of 24 PD patients and 31 eyes of 17 control subjects underwent a comprehensive ophthalmologic examination. We used optical coherence tomography to examine retinal thickness, separately quantifying the inner and outer retinal layers. Intraocular pressure was measured by Goldmann applanation tonometry. Results The mean (SD) ages of the patients with PD and healthy subjects were 64.0 (6.5) years vs 63.5 (10.7) years (P = .77). The mean (SD) intraocular pressure was 13.6 (+/–2.7) mm Hg in the PD patients. No difference was found in either the superior or inferior outer retinal layer thickness of PD vs control eyes. The mean (SD) superior inner retinal layer thickness of PD vs control eyes was 88.79 (11.3) µm vs 103.5 (24.3) µm (P = .01), and the mean inferior inner retinal layer thickness was 89.83 (11.1) µm vs 104.0 (23.5) µm (P = .01). Conclusions The inner retinal layer is significantly thinner in PD patients than in healthy subjects. Idiopathic PD, distinct from glaucoma, needs to be considered in the differential diagnosis of retinal nerve fiber layer thinning.

OPHTHALMOLOGICAL EPHEMERA: Dr Thompson's Eye Water

CLINICAL SCIENCES: Prevalence and Sex Differences of Psychiatric Disorders in Young Adults Who Had Intermittent Exotropia as Children

Objective To evaluate the prevalence and sex differences of mental disorders diagnosed among young adults who had intermittent exotropia (IXT) as children. Methods The medical records of all children (<19 years) diagnosed as having IXT as residents of Olmsted County, Minnesota, from January 1, 1975, through December 31, 1994, and their randomly selected nonstrabismic birth- and sex-matched controls (1:1) were retrospectively reviewed. Results A mental health disorder was diagnosed in 97 (53.0%) of the 183 patients with childhood IXT followed to a mean age of 22 years compared with 55 (30.1%) controls (P < .001). Patients with IXT were 2.7 (95% confidence interval, 1.7-4.1) times more likely to develop a psychiatric illness than controls. A mental health disorder was diagnosed in 63% (41 of 65) and 47% (56 of 118) of males and females with IXT, respectively, compared with 33% (22 of 66) and 28% (33 of 117) of male and female controls, respectively. Additionally, males with IXT had a greater use of psychotropic medication (P = .003), psychiatric emergency department visits (P < .001), psychiatric hospital admissions (P = .04), suicide attempts (P = .004), and suicidal ideation (P = .002) than controls, and females with IXT had more suicidal ideation (P = .02) than controls. Conclusions Children diagnosed as having IXT, especially males, are more likely to develop mental illness by the third decade of life compared with children without strabismus.

CALL FOR PAPERS: Surgeon's Corner

CLINICAL SCIENCES: Use of a Continuous Probability Scale to Display Visual Field Damage

Objective To derive and display the percentile score (1st-99th percentile) at each perimetric location of a standard automated perimetry test to determine whether this technique will uncover patterns of loss not visible in standard (StatPac) probability maps. Methods We computed continuous scale probability plots of data collected from testing 305 visually healthy participants with standard automated perimetry (24-2 Swedish interactive thresholding algorithm). The age-corrected thresholds were sorted by sensitivity at each visual field location. Percentiles were derived in single increments from the 1st to the 99th. We displayed the percentiles as a color scale and then interpreted visual field plots from healthy control subjects and patients with visual system disorders. Results Added information was achieved for identifying patterns of visual loss by using the 5th- to 20th-percentile range in conjunction with the lower range below the 5th percentile that is typically used. The extent of contiguous regional defects appeared larger using this method. Healthy control subjects often have threshold results within the 5th- to 20th-percentile range, but these test locations usually appeared randomly spaced rather than in contiguous patterns commonly seen in patients at the border of visual field defects. Conclusion Continuous scale probability plots are a potentially useful adjunct for interpretation of perimetry results.

FROM THE ARCHIVES OF THE ARCHIVES: A look at the past . . .

CLINICAL SCIENCES: Kinematic Analysis of Surgical Dexterity in Intraocular Surgery

Objective To evaluate the potential of motion analysis as a discriminator of surgical skill during intraocular surgery. Methods Twenty-four subjects were divided into 3 groups (n = 8 each) based on the number of completed phacoemulsification procedures: novice (n < 10), intermediate (n = 10-150), and expert (n > 150). The Qualisys motion-capture system obtained data from the surgeons performing (1) corneal wound construction (incision), (2) continuous curvilinear capsulorrhexis (CCC), and (3) phacoemulsification lens extraction on artificial eyes. The main outcome measures were time, overall path length, and total number of movements. Statistical significance was set at P < .05. Results For the incision task, significant differences between the levels of experience were found for time (P = .001), number of movements (P = .001), and path length (P = .05). For the CCC task, significant differences were found between groups for time (P = .03) and number of movements (P = .03), but not for path length (P = .08). For the phacoemulsification task, significant differences were found between the 3 groups for time (P = .04), path length (P = .02), and number of movements (P = .04) Conclusions Motion analysis differentiated between surgeons with varying levels of experience performing phacoemulsification tasks, thus demonstrating construct validity. This technique may be useful in the objective quantitative measurement of microsurgical skill with potential applications for training and research.

ARCHIVES WEB QUIZ WINNER: January 2009 Archives Web Quiz Winner

EPIDEMIOLOGY: Prevalence of Dry Eye Disease Among US Men: Estimates From the Physicians' Health Studies

Objective To estimate the prevalence and risk factors for dry eye disease (DED) among US men. Methods Cross-sectional prevalence survey among male participants 50 years and older in the Physicians' Health Studies I (N = 18 596) and II (N = 6848). We defined DED as the presence of clinically diagnosed dry eye or severe symptoms (both dryness and irritation constantly or often). We calculated the age-standardized prevalence of DED adjusted to the age distribution of US men in 2004 and projected estimates forward to 2030. We compared DED prevalence with a similar cohort of women and examined associations with possible risk factors. Results The prevalence of DED increased with age, from 3.90% among men aged 50 to 54 years to 7.67% among men 80 years and older (P for trend <.001). High blood pressure (odds ratio, 1.28; 95% confidence interval, 1.12-1.45) and benign prostatic hyperplasia (odds ratio, 1.26; 95% confidence interval, 1.09-1.44) were associated with a higher risk of DED. Use of antidepressants, antihypertensives, and medications to treat benign prostatic hyperplasia were also associated with increased risk of DED. The age-standardized prevalence of DED was 4.34%, or 1.68 million men 50 years and older, and is expected to affect more than 2.79 million US men by 2030. Conclusions Dry eye disease is prevalent and increases with age, hypertension, benign prostatic hyperplasia, and antidepressant use.

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EPIDEMIOLOGY: Associations Between Near Work, Outdoor Activity, and Myopia Among Adolescent Students in Rural China: The Xichang Pediatric Refractive Error Study Report No. 2

Objective To study the associations between near work, outdoor activity, and myopia among children attending secondary school in rural China. Methods Among a random cluster sample of 1892 children in Xichang, China, subjects with an uncorrected acuity of 6/12 or less in either eye (n = 984) and a 25% sample of children with normal vision (n = 248) underwent measurement of refractive error. Subjects were administered a questionnaire on parental education, time spent outdoors, and weekly time spent engaged in and preferred working distance for a variety of near-work activities. Results Among 1232 children with refraction data, 998 (81.0%) completed the near-work survey. Their mean age was 14.6 years (SD, 0.8 years), 55.6% were girls, and 83.1% had myopia of –0.5 diopters or less (more myopia) in both eyes. Time and diopter-hours spent on near activities did not differ between children with and without myopia. In regression models, time spent on near activities and time outdoors were unassociated with myopia, adjusting for age, sex, and parental education. Conclusions These and other recent results raise some doubts about the association between near work and myopia. Additional efforts to identify other environmental factors associated with myopia risk and that may be amenable to intervention are warranted.

EPIDEMIOLOGY: Myopia, Spectacle Wear, and Risk of Bicycle Accidents Among Rural Chinese Secondary School Students: The Xichang Pediatric Refractive Error Study Report No. 7

Objective To study the effect of myopia and spectacle wear on bicycle-related injuries in rural Chinese students. Myopia is common among Chinese students but few studies have examined its effect on daily activities. Methods Data on visual acuity, refractive error, current spectacle wear, and history of bicycle use and accidents during the past 3 years were sought from 1891 students undergoing eye examinations in rural Guangdong province. Results Refractive and accident data were available for 1539 participants (81.3%), among whom the mean age was 14.6 years, 52.5% were girls, 26.8% wore glasses, and 12.9% had myopia of less than –4 diopters in both eyes. More than 90% relied on bicycles to get to school daily. A total of 2931 accidents were reported by 423 participants, with 68 requiring medical attention. Male sex (odds ratio, 1.55; P < .001) and spectacle wear (odds ratio, 1.38; P = .04) were associated with a higher risk of accident, but habitual visual acuity and myopia were unassociated with the crash risk, after adjusting for age, sex, time spent riding, and risky riding behaviors. Conclusion These results may be consistent with data on motor vehicle accidents implicating peripheral vision (potentially compromised by spectacle wear) more strongly than central visual acuity in mediating crash risk.

OPHTHALMIC MOLECULAR GENETICS: Novel PRPF31 and PRPH2 Mutations and Co-occurrence of PRPF31 and RHO Mutations in Chinese Patients With Retinitis Pigmentosa

Objective To screen mutations in the PRPF31, RHO, and PRPH2 genes in Chinese patients with retinitis pigmentosa (RP). Methods Patients with RP were recruited from Retina Hong Kong. All the exons of the PRPF31, RHO, and PRPH2 genes were amplified and screened for mutations using single-stranded conformation polymorphism analysis followed by DNA sequencing. Frequencies of sequence changes were determined in patients and controls. Results In 76 patients from 54 families, 3 pathogenic mutations and 32 nonpathogenic sequence changes were identified. One family with autosomal dominant RP was found to harbor a novel truncating PRPF31 mutation (p.Phe262SerfsX59) and a known missense RHO mutation (p.Pro347Leu), and 1 affected woman was heterozygous for both mutations. One simplex RP case was caused by a novel truncating PRPH2 mutation (p.Ala78LeufsX99). Thirteen of the 32 nonpathogenic sequence changes were novel and were found in low frequencies in patients with RP and controls. Conclusions Mutations in PRPF31, RHO, and PRPH2 were found in low frequencies (1 of 9 autosomal dominant RP families) in Chinese patients, and the PRPF31 and PRPH2 truncating mutations were novel. Clinical Relevance A search for a common cause for RP in Chinese patients is needed. The co-occurrence of 2 different gene mutations may modify the phenotype severity.

SURGICAL TECHNIQUE: Internal Drainage of a Retinal Macrocyst With an Nd:YAG Laser to Aid Primary Retinal Reattachment

Retinal macrocysts are an occasional finding in patients with long-standing retinal detachments. The cysts usually do not require any specific treatment during procedures to repair retinal detachment and resolve spontaneously after retinal reattachment. However, if the cyst is adjacent to a retinal break and prevents its closure, the retinal reattachment procedure can fail. We describe a technique using the Nd:YAG laser to perforate the retinal cyst postoperatively, which allows for subsequent break closure and retinal reattachment.

SOCIOECONOMICS AND HEALTH SERVICES: Retinopathy of Prematurity Malpractice Claims: The Ophthalmic Mutual Insurance Company Experience

Objective To examine the causes of retinopathy of prematurity (ROP) malpractice claims filed with the Ophthalmic Mutual Insurance Company. Methods All closed ROP malpractice claims were reviewed. Results Eight cases involved failure of transfer of care on patient discharge from the hospital, 3 cases demonstrated inappropriately long periods between follow-up examinations, 1 case was due to failure of outpatient referral from screening to the treating ophthalmologist, and 1 case concerned unsupervised resident provision of ROP care. Conclusions Many preventable factors can be addressed to improve ROP care. It is essential to ensure that ophthalmologists, neonatologists, pediatricians, and families are updated on current guidelines for ROP screening and treatment and to facilitate follow-up appointments before patient discharge from the hospital. Doing so can help avoid future malpractice claims and patient harm.

EDITORIAL: Uncovering the Risks of Immunosuppressive Therapy in Patients With Uveitis

EDITORIAL: To Mask or Not to Mask

EDITORIAL: Retinopathy of Prematurity Malpractice Claims

ANNOUNCEMENT: Topic Collections

EDITORIAL: Technological Advances in Pediatric Eye Care

CONTROVERSIES: Pediatric Refractive Surgery

CONTROVERSIES: Refractive Surgery for Special Needs Children

CONTROVERSIES: Pediatric Refractive Surgery Review

SMALL CASE SERIES: In Vivo Confocal Microscopy of the Cornea in Darier-White Disease

OBITUARY: Rocko Fasanella, MD (1916-2009)

RESEARCH LETTERS: Infliximab Therapy for Refractory Uveitis: 2-Year Results of a Prospective Trial

RESEARCH LETTERS: Recalcitrant Candida Endophthalmitis Associated With Mannose-Binding Lectin Deficiency

RESEARCH LETTERS: Complex Choristoma Masquerading as a Dacryocystocele

LETTERS: Smoking and Age-Related Macular Degeneration

LETTERS: Smoking and Age-Related Macular Degeneration--Reply

LETTERS: Simultaneous Adduction and Convergence Retraction: The Verisimilitudes for Synergistic Convergence

LETTERS: Simultaneous Adduction and Convergence Retraction: The Verisimilitudes for Synergistic Convergence--Reply