فهرست مطالب خلیل قاسمی فلاورجانی

  Promotion of Ophthalmic Education and practice is one of the main priorities for policy makers in ophthalmology. This study aimed to present experts solutions to accomplish an Ideal Status for Ophthalmic Fellowship Education in Iran over a 10- year horizon.

In this applied qualitative research, using purposive sampling, 11 key informants of Iran’s Ophthalmic Fellowship Education invited to participate in an expert panel on February2023. The data analyzed by thematic approach.

 in this article the identified solutions to achieve desired status for fellowship education in ophthalmology were presented in 14 main themes, and 44 subthemes.Based of consensus of experts, this study, proposed 14 applied solution including: Revising the ophthalmic fellowship curriculum to the highest quality, promoting accountability, promoting professionalism , constant interaction with clinical research sectors,  reform in national system of  fellowship’s admission, reform in fellowships  program evaluation  and accreditation system, decentralization of ophthalmic fellowship admission, Integration of some ophthalmic fellowship disciplines, cut unnecessary admissions and increase admissions in required  ophthalmic fields , foresight  in workforce planning ,  cost-effectiveness analysis  in fellowship programs development , ophthalmic services tariffs reform, Ophthalmologists retention policy reform , Investing and building technological infrastructures.

 The priority areas and applied solutions to actualize the ideal situation for ophthalmic fellowship education of the highest quality in response to community and health system demands are determined .The experts recommendations should be considered through revision of policies, standards and practical mechanisms by educational  planners to promote ophthalmic fellowship education in IRAN.

Development of Fellowship Education is constantly one of the strategies of medical education policy makers because of the key role of graduated fellowships in advanced health care. This study aimed to comprehensively analyzes the current status for Ophthalmic Fellowship Education in Iran.

In this applied qualitative foresight study, using purposive sampling, eleven experts and key informants of Iran’s Ophthalmic Fellowship Education, selected, and invited to participate in a panel of experts. A panel meeting for focused discussion was held on February2023. The data analyzed by thematic approach.

The identified strength points and challenges are presented in 23 main themes, and 65 subthemes. The seven main themes for strengths included, systematic management, successful policies in ophthalmology education, effectiveness of fellowship programs, increasing motivation for academic growth, faculty empowerment, improving access to advanced services, avoiding procedures with questionable indications.
Sixteen themes for challenges included: low educational quality in some centers, lack of community based education, weak professional ethics, low quality of research, lack of comprehensiveness, lack of futuristic approach in developing fellowships, lack of workforce planning, ineffective evaluation system , ineffective centralized admission system, unbalanced admission capacity, receiving fellowship degree to make extra income, performing ophthalmic procedures not related to their fellowship fields , refuse to operate high risk ophthalmic procedures, unattractive Tariffs, regional disparity of medical resources, shortage of advanced technological infrastructures.

Based on experts’ consensus, forward-looking planning is effective in order to maintain the achievements, solve the challenges and improve these courses in line with the desired perspective.

To analyze the correlation of optical coherence tomography angiography (OCTA) findings with visual acuity (VA) in patients with branch retinal vein occlusion (BRVO).

This cross-sectional study was performed on 20 eyes of 20 patients with unilateral BRVO involving the macula referred to the ophthalmology clinic of Rassoul Akram Hospital. OCTA imaging was conducted for all patients and the correlation of the obtained data including vascular density and foveal avascular zone (FAZ) area with visual acuity was evaluated.

The patients included 11 men and 9 women with a mean age of 63.9±8.47 (Aged 49-77 years). Branch retinal vein occlusion involved the superotemporal and inferotemporal quadrants in 11 and 9 eyes, respectively. The mean best-corrected visual acuity was 0.86±0.88 logMAR. The vascular density of deep capillary plexus did not differ in the parafoveal involved and uninvolved areas (P= 0.087). No significant difference was observed in the vascular density of superficial capillary plexus between the involved and uninvolved areas (P= 0.715). The difference in vascular density between involved quadrants was not statistically significant. The vascular density of deep and superficial capillary plexuses in the involved area did not correlate with age, sex, visual acuity, macular thickness, FAZ, number of previous injections, distance to the last injection, and duration of disease.

In this study, no statistically significant association was found between visual acuity and OCTA findings, including vascular density and foveal avascular zone area.

To compare ophthalmic artery velocity in eyes with nonarteritic anterior ischemic optic neuropathy (NAION) with that of normal fellow eyes.

In this case-control study, 20 patients with unilateral NAION and disease onset less than 8 weeks, were enrolled. Using color Doppler imaging, mean, maximum systolic and end diastolic ophthalmic artery velocities were evaluated. The results were compared between the fellow eyes.

Twelve men and 8 women with a mean age of 54.6±11.8 years were included. Mean interval between disease onset and velocity measurements was 27.5±12.8 days. Mean (18.5±0.8 vs 19.9±2.8), maximum systolic (37.9±4.09 vs 39.7±3.1) and end diastolic (10.3±2.1 vs 12.3±2.5) ophthalmic artery velocities in NAION eyes were significantly less than that of the normal fellow eyes (P=0.01, P=0.001 and P<0.001, respectively). No significant difference was found in subgroup analysis of patients with and without diabetes, and with and without systemic hypertension.

NAION seems to be associated with changes in ophthalmic artery velocity.

Age-related Macular Degeneration (AMD) is one of the most important causes of irreversible blindness in the developed world and prevents the affected person from performing simple tasks such as reading, driving and facial recognition. In the AMD, new blood vessels grow underneath the retina in a process called choroidal neovascularisation (CNV). There is much interest in the quantification of the angiographic features of CNV, as these parameters are used as markers for monitoring the response to CNV treatment. To date, the techniques used in angiographic analysis are based on subjective interpretation by experienced clinicians. The goal of the present study was to propose an automatic algorithm for determining the extent of CNV.

The proposed algorithm was used to analyze indocyanine angiograms of 12 patients with CNV. The angiograms were acquired by a confocal scanning laser ophthalmoscope. The algorithm included an adaptive Wiener filtering technique, a top-hat morphology method and a new thresholding technique based on a modification of Otsu’s method. The area of each lesion was obtained and compared with a subjective evaluation of CNV. Finally, each area was expressed in square millimeters by making a cylindrical tube filled with indocyanine green.

The CNV area was determined by the proposed algorithm and an observer. No significant differences were observed between the two data sets (p>0.05). Discussion and

This study demonstrates that the proposed algorithm based on a modification of Otsu’s method can be used to measure the area of CNV.

To investigate central corneal thickness (CCT), endothelial cell characteristics and intraocular pressure (IOP) in congenital cataract extracted eyes and to compare the results with eyes of normal age and sex matched controls.

CCT and IOP measurements and specular microscopy were performed in 31 eyes of 17 cases of extracted congenital cataracts and 40 eyes of 20 age and sex matched subjects as control group. Mean of three pachymetry measurements of the central cornea was taken as CCT. IOP was measured using an applanation tonometer.

Mean CCT was 632 ± 45 µm in cataract extracted eyes vs 546 ± 33 µm in the control eyes (P<0.001, independent t test and Mann Whitney test). There was no significant difference in cell count, coefficient of variation, and mean cell area of the corneal endothelial cells between the two groups. Mean IOP was 22.1 ± 3.9 mmHg in the cataract extracted eyes and 14.0 ± 1.6 mmHg in the control group (P<0.001, independent t test).

Although the cornea was clinically clear and there was no significant difference in endothelial characteristics of congenital cataract extracted eyes compared to normal controls, central corneal thickness in operated eyes was significantly greater than that of controls. To differentiate actual glaucoma from artifactual IOP increase, CCT measurement should strongly be considered in these patients.