THIS WEEK'S ARTICLES
Can Eye Surgeons Learn Through Zoom?
Remote training helps medical students grasp basic surgical skills.
Telehealth and virtual meetings were normalized out of necessity during the pandemic. Now researchers are exploring the possibility of tapping into video conferencing platforms to train the surgeons of tomorrow.
Twenty students enrolled in the ophthalmology master's program at University College London in England took part in a recent study, which was published in the journal Eye, to determine if basic ophthalmic surgical skills can be taught through the Zoom videoconferencing program.
The learning session began with synchronous group teaching about suture supplies and handling. Students then watched prerecorded videos on tying a slip knot with a cable (so they could first learn the skill on a macro level), suturing and tying a reef knot, suturing and tying a slip knot and tying a trabeculectomy releasable suture.
The videos were recorded using the "surgeon's view" — a specific camera angle enabling the students to see exactly what the surgeon sees — which closed the gap between face-to-face instruction and virtual learning. Finally, students were assigned to virtual breakout rooms to practice the skills under direct supervision of an instructor.
Nearly all the students were satisfied or very satisfied with the experience and most said they gained more confidence in their abilities to handle instruments and tie cables and sutures. One student remarked, "Most enjoyable session of the course so far. I liked that we had instructors with us in the breakout rooms to ask about any steps we were unsure about. Also, the demonstration videos beforehand were very useful."
Although remote learning has inherent limitations, this virtual ophthalmic surgical skills training demonstrates new methods of teaching future surgeons during the post-pandemic era. The study shows educational sessions can be completed successfully through virtual platforms that offer a way to deliver presentations, instructional videos and skills training in an engaging format.
"Remote learning has improved the equitability and accessibility of medical education," write the study's authors. "By conducting this session online, we were able to widen participation, which has future implications for surgical skills teaching and its reach."
New Study Will Examine Cause of Cataracts
The $1.6-million NIH-funded effort hopes to develop new nonsurgical treatments.
Researchers from the University of Arizona College of Medicine in Tucson are leading a study to identify the biological mechanisms that cause cataracts, with hopes of developing new nonsurgical treatments for the condition.
The study will focus on the role of two protein ion channels called TRPV1 and TRPV4 in the development of cataracts. "Human cataract is frequently associated with failure of the mechanisms controlled by TRPV1 and TRPV4," says Nicholas Delamere, PhD, an ophthalmology professor and head of the university's physiology department. "The hope is that studies like this might pave the way to the development of strategies to prevent or delay age-related eye diseases."
Funded by a $1.6 million grant from the U.S. National Institutes of Health's National Eye Institute, the study will attempt to advance an existing discovery made by Dr. Delamere and the research team, who found that TRPV4 and TRPV1 cooperate to regulate cell function in the highly specialized cells of the eye lens.
Lens transparency requires precise maintenance of ion and water content, but the lens is made from tightly packed layers of cells that are incapable of independently maintaining ion and water homeostasis. Protein ion channels like TRPV4 and TRPV1, acting as pores in the cell membrane, permit ions including potassium, sodium and calcium to pass in and out of the cell.
Scientists don't yet understand the maintenance of lens transparency, but the development of cataract has been linked to failure of biological mechanisms controlled by TRPV1 and TRPV4. Dr. Delamere's prior research shows that TRPV1 and TRPV4 in cells on the surface of the lens act as sensors for the control mechanisms that regulate the lens' entire structure, including water content, size, shape, optical clarity and focusing power.
The new study will examine how tiny changes in hydrostatic pressure in the lens' surface cells activate TRPV1 and TRPV4 to make homeostasis possible. The research team also hopes to characterize the molecular link between TRPV1 and TRPV4 and the cell's interior framework.
Innovations in Imaging Technologies Benefit Both Ophthalmologists and Their Patients
Whether upgrading existing systems or adding new equipment, surgery centers need to stay current to best serve their communities.
The world of eye surgery is changing as new innovations and upgrades of imaging systems enter the market. Surgeons will need to stay up to date and learn about new camera systems and what the future holds as they grow their businesses. We spoke with Manny Desai, Regional Sales Director at Panasonic i-PRO Sensing Solutions Corporation of America, to learn what is new in camera systems, as well as the most recent technology advances.
Q: What types of camera systems are especially suitable for outpatient surgical eye procedures?
Camera technology is evolving at a faster pace than ever before. Not too long ago, we migrated from "standard-definition" cameras to "high-definition" camera systems. Now imaging technology is advancing to 4K resolution with an image quality that rivals what one can see directly through a microscope's ocular.
Q: Can you describe the benefits of these camera systems?
There are three significant benefits that 4K cameras bring to the field of outpatient surgery:
- The camera systems are a great tool for education, providing students with crystal-clear views of the procedures.
- New 3-sensor cameras deliver higher sensitivity, detailed resolution and accurate color reproduction which leads to positive patient outcomes.
- The lower price points of these new devices make them more accessible to more outpatient surgery facilities.
Q: What are the latest devices being shown today?
A new 3D heads-up imaging system is becoming popular. It allows surgeons to perform procedures by looking at a 3D monitor. This greatly reduces neck strain and improves efficiency by eliminating the need to look through a microscope during an operation.
Q: Are ophthalmologists adopting the latest imaging technologies?
Yes, many ophthalmologists demand the best microscopes and imaging systems and typically look to adapt to the latest technologies whenever possible. However, with many hospitals merging and the emergence of ambulatory surgical centers, it's often not feasible, or economical, to upgrade capital equipment within a large surgery system. Upgrading the imaging capabilities of existing systems with innovations like new 4K cameras, helps enhance older microscopes and provides a great, cost-effective alternative.
Q: How adaptable are older imaging systems with what is being introduced on the market today?
Older cameras were the workhorse in the past for outpatient surgical centers. However, in comparison to new 4K cameras, they produce images that look like they're being viewed through a dirty lens. The image seems cloudy in comparison to an HD camera or the 4K camera system. In addition, recording technology has also greatly improved, allowing surgeons to store high-quality and high-resolution video and still images of each patient on a USB drive or network recorder/server.
Q: What are the advantages of cameras with high dynamic range?
A typical camera system – either a single sensor or 3-sensor camera – controls image brightness electronically. However, there is a limit of compensation a camera can provide. A high-dynamic camera, or HDR camera, can discern the high contrast image (dark area and bright area simultaneously). We believe that HDR cameras can help surgeons and students obtain a clearer view of the posterior segment.
Q: How important is it for ophthalmology outpatient facility leaders to stay up to date on the latest camera systems? How can they learn about them?
It's all about creating value and providing great care for patients. For example, a facility using old equipment or resisting upgrades due to economic reasons may not attract highly regarded eye surgeons to their facility. Therefore, it's imperative to refresh equipment with the latest technology every few years and be current. Facility leaders can learn more about our camera system by visiting the i-PRO website or calling our skilled technical staff.
Panasonic i-PRO Sensing Solutions Co., Ltd., is a global leader of advanced sensing technologies in the fields of Intelligent Surveillance, Public Safety and Industrial/Medical Imaging. Established in 2019, i-PRO was built on a legacy of over 60 years of innovation with Panasonic. The company's products, software and services extend human senses to capture moments of truth with innovations that inform and protect. In order to help create a safer world, Panasonic i-PRO Sensing Solutions Co., Ltd., supports the work of professionals who protect and save lives.
For more information visit https://i-pro.com/us/en/medicalimaging/.
Promise for Sufferers of Age-Related Macular Degeneration
A new subretinal implant has been shown to improve vision in legally blind patients.
Recently published data from the University of Southern California (USC) shows a stem-cell derived implant designed to improve vision for patients suffering from age-related macular degeneration can safely be inserted into the eye without the need for long-term immunosuppressants. This result could be a breakthrough in the effort to provide sight to patients suffering from retinal blindness.
Macular degeneration is one of the most common forms of blindness in adults over 40. The data, published last month in Stem Cell Reports, involves a new subretinal implant invented by USC ophthalmology professor Mark Humayun, MD, PhD, who says it has been shown to improve vision in some patients who suffered from dry age-related macular degeneration.
"There's been some debate on whether stem cells derived from a different, unrelated person would survive in the retina without long-term immunosuppression," says Dr. Humayun. "For instance, if you were to receive a kidney transplant, long-term immunosuppression would be required to prevent organ rejection. This study indicates the cells on the retinal implant can survive for up to two years without long-term immunosuppression."
The bioengineered implant, defined as a scaffold, is implanted under the retina. It's comprised of stem cell-derived retinal pigmented epithelial (RPE) cells, which are defective in dry age-related macular degeneration. To improve the odds of the body's successful adoption of the implant, doctors in the trial used low-dose immunosuppression drugs just before and for shortly after implantation, a period of approximately two months.
Despite the absence of long-term immunosuppression, the researchers did not find any clinical signs of rejection of the mismatched donor cells. "These findings show the implant can improve visual function in some patients who were legally blind before treatment, and that the cells on the implant survive and remain functional for at least two years despite not being matched with those of the patient," says Dr. Humayun.
Pediatric Cataract Surgery Patients Require Frequent Monitoring
Providers should watch for glaucoma, visual axis obscuration and refractive error.
Cataract surgery is generally thought of a procedure for older patients, but cataracts can also be present in newborns and children, caused by congenital or acquired factors such as diabetes or eye injuries. In many cases, the specific cause is unknown. While it's important to remove cataracts from children before they cause permanent damage, a new study has raised concerns about the long-term effects of performing lensectomies on children.
Researchers examined visual outcomes and complications within five years of pediatric cataract surgery and found that ophthalmology providers should closely and carefully monitor children younger than 13 years of age for the development of potentially devastating complications. The researchers' goal was to assess the patients' post-op visual acuity, incidence of complications, additional eye operations and refractive error outcomes.
The prospective cohort study of 994 children (1,268 eyes) who underwent lensectomy, published last month in JAMA Ophthalmology, explored data from the Pediatric Eye Disease Investigator Group clinical research registry about patients who underwent bilateral and unilateral cataract surgeries from 2012 to 2015. The data was enhanced through annual reviews of the patients' medical records until 2020.
The researchers describe the development of glaucoma or glaucoma suspect as "common" in children five years after lensectomy. Myopic shift was "modest" during the five years after placement of an intraocular lens, a conclusion that the researchers note should factor into implant power selection for pediatric patients.
"These results support frequent monitoring after pediatric cataract surgery to detect glaucoma, visual axis obscuration causing reduced vision, and refractive error," they conclude.