Vitreo-retinal disorders have an important role in decreasing
vision worldwide1 as well as in Pakistan2. Importance
of early and correct diagnosis of vitreo-retinal disorders cannot be
underestimated, for its effective management and prevention of blindness. Early
detection of vitreo-retinal disorders is often difficult due to unavailability
of vitreo-retinal surgeons or non referral by general ophthalmologists. Diabetes3,
hyprtension4, ischemic heart diseases5, pregnancy6,
radiations7, premature births8 have an important impact
on retina leading to markedly decreased vision. Nowadays anti-VEGF9 and
argon laser10 have an important role in treating retinopathies described
by all above predisposing conditions. These modalities of treatment are highly
effective when prescribed to a well diagnosed and deserving patient at the
right time. Assessment of pathology is the first step in the planning of
disease management. Non availability of vitreo-retinal surgeons and lack of
referral by general ophthalmologists are among the major reasons for late,
wrong diagnosis and improper management of vitreo-retinal disorders.
Intra vitreal anti-VEGF injections are prescribed by vitreo-retinal
specialists rather than general ophthalmologists. Due to increasing prevalence
of age related retinal disorders in west general ophthalmologists are thinking
to manage it in collaboration with vireo-retinal specialists. Such a survey has
been published in which different views were discussed regarding advise of
intra vitreal anti VEGF. Finally it was concluded that a vitreo-retinal
specialist should advise and inject intra-vitreal anti VEGF. In addition a vitreo-retinal
specialist can handle any complication related to intra vitreal anti-VEGF more
competently. General ophthalmologist can advise and treat after proper training
under vitreo-retinal specialist11. Another report has been published
in USA, in which for diagnostic tests and management of retinal disorders
including intra-vitreal anti-VEGF, PRP, grid and focal laser patients were
referred to vitreo-retinal specialist12.
To the
best of our knowledge literature estimating the awareness among ophthalmologists
about the role of vitreo-retinal surgeons is not available from Pakistan. The
present study is designed to evaluate the awareness among ophthalmologists of
Pakistan about the role and need of retinal surgeons in dealing with vitreo-retinal
disorders.
MATERIAL AND METHODS
A questionnaire based survey, involving 610 ophthalmologists was
conducted through random sampling. The questionnaire was structured to evaluate
the level of awareness among a random population of ophthalmologists about the role
of vitreo-retinal surgeons in prescribing and treating with anti vascular
endothelial growth factors (VEGFs) and retinal lasers.
Survey was conducted during three national congresses and
ophthalmological society monthly meetings and in different ophthalmology
departments of the city. The questionnaire was designed in English and was
pilot tested on 25 ophthalmologists to assess any query regarding understanding
of questions.
The questionnaire had two sections. First section had seven
questions about the awareness of the role of retinal surgeons in managing vitreo-retinal
disorders. Section two pertained to the participant’s personal data including
name and hospital name. Name of participant was kept optional. Each question
had three options and the respondent had to tick the response of their choice.
This final version of questionnaire was given to actual participants of the
survey.
Six hundred and ten ophthalmologists of variable age were enrolled
by random sampling. The enrollment was done by distributing questionnaires
randomly before the start of scientific sessions and collected back after the
end of sessions. The approximate population (ophthalmologists) attending these
ophthalmic conferences and meetings was 3000 at 95% confidence level and
confidence interval of 1.5; the required sample size was 200. The survey was
done by ophthalmologists.
Statistical
package SPSS version 15.0 was used for data analysis.
RESULTS
Among
610 ophthalmologists enrolled for the survey, responses from all participants
were evaluated. Out of 610 participants 479 (78.5%) were in favor of referring
the patient with vitreo-retinal diseases to retina specialists while 131
participants were against it. There were 138 (22.6%) participants in favor of
advising intra-vitreal injections by general ophthalmologists out of the total
participants. There were 141 (23.11%) participants in favor of injecting intra-vitreal
injections by general ophthalmologists out of the total participants. There
were 279 (45.73%) participants in favor of doing focal laser and PRP by general
ophthalmologist. There were 469 (76.88%) participants in favor of injecting
intra-vitreal injections by retinal surgeons. There were 331 (54.26%)
participants in favor of doing focal
laser and PRP by retinal surgeons. There were 472 (77.37%) participants in
favor of advising intra-vitreal injections by vitreo-retinal surgeons. Participant’s
responses regarding questionnaire are shown in bar chart with respect to each
question separately (Figure 1).
.doc%20final_files/image003.gif)
Fig. 1: Participant’s responses
regarding questionnaire.
Questionnaire
Q.1 Patient of vitreo retinal disease should be referred to vitreo
retinal specialist by general ophthalmologist?
Yes No
Q.2 Intra vitreal injections should be advised by general
ophthalmologists?
Yes No
Q.3 Intra vitreal injections should be injected by general
ophthalmologists?
Yes No
Q.4 Focal lasers and PRP should be performed by general
ophthalmologists?
Yes No
Q.5 Intra vitreal injections should be injected by vitreo retinal
specialist?
Yes No
Q.6 Focal laser and PRP should be perfomed by vitreo retinal
specialist?
Yes No
Q.7 Intra vitreal injections should be advised by vitreo retinal
specialist?
Yes No
DISCUSSION
This was a double blinded survey with minimum bias. This study
assesses the awareness and knowledge about the need and role of vitreo-retinal
surgeon in assessing and managing vitreo-retinal disorders among
ophthalmologists participating in ophthalmic conferences, clinical meetings and
in different ophthalmology departments. The intent of the survey was to
highlight the importance of specialized vitreo-retinal surgeons in securing
maximum vision in minor or vision threatening vitreo-retinal disorders.
Most of the ophthalmologists were well aware of need and
importance of vitreo-retinal surgeons. Lack of awareness and non referral to vitreo-retinal
surgeon often lead to under-diagnosis or late presentation to vitreo-retinal
specialist leading to profound deterioration of curable vision. Timely vitreo-retinal
consultation can improve visual outcome. A meta-analysis suggested that scleral
buckling for macular detachment must preferably be performed within 3 days to
optimize visual outcome.13 another study was done explaining that
chronicity of retinal detachment at presentation is an important and poor
prognostic indicator for reattachment surgery14. Laser treatment by
an experienced vitreo-retinal surgeon in time can save vision in many retinal
disorders i.e Proliferative diabetic retinopathy15, retinal vascular
occlusions16, angiomatous proliferation in age related macular
degeneration17. Anti-VEGF advised by a certified vitreo-retinal
surgeon after proper diagnosis can dramatically improve vision in conditions
e.g wet age related macular degeneration18, Diabetic macular edema19,
retinal vein occlusion20,21 etc.
Overall
the awareness among ophthalmologists in Pakistan is good regarding the role of vitreo-retinal
specialists and their importance in managing vitreo-retinal disorders. The
findings of our study shed light on the level of awareness about the role and
need of vitreo-retinal specialists among ophthalmologists in Pakistan. This
awareness can lead to early detection, proper management and improvement of
visual prognosis in vitreo-retinal disorders. Furthermore there is still need
to identify interventions e.g conduction of seminars, workshops, talks etc that reinforce ophthalmologist’s attitude above the
perceived level of awareness and devise strategies for the betterment of
patients. No such data is published earlier to compare.
CONCLUSION
Ophthalmologists
believe that retinal disorders should be treated by a vitreo-retinal surgeons.
The survey findings stress the need for referral of vitreo-retinal disorders to
vitreo-retinal surgeons.
Author’s Affiliation
Dr. Hussain
Ahmad Khaqan
Assistant
Professor, Eye unit ll
Lahore
General Hospital
Lahore
Prof.
Abdul Hye
Professor,
Eye Unit II,
Lahore
General Hospital,
Lahore
Dr. Hassan
Raza Ch.
Assistant
Professor (Ophthalmology)
Amir ud
Din Medical College
PGMI/
Lahore General Hospital
Lahore
Role of Authors
Dr.
Hussain Ahmed Khaqan
Performa
design, Article writing and collecting data
Prof.
Abdul Hye
Manuscript
Review.
Dr.
Hassan Raza Ch
Composing
of article & collection of performa
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