Katherine A. Joltikov

Background/Objectives: Fluorescein angiography (FA) is essential for diagnosing and managing diabetic retinopathy (DR) and other retinal vascular diseases and has recently demonstrated potential as a quantitative tool for disease staging. The advent of ultra-widefield (UWF) FA, allowing visualization of the peripheral retina, enhances this potential. Retinal hypoperfusion is a critical risk factor for proliferative DR, yet quantifying it reliably remains a challenge. Methods: This study evaluates the efficacy of the Michigan grid method, a software-based grading system, in detecting retinal hypoperfusion compared to the traditional freehand method. Retinal UWF fluorescein angiograms were obtained from 50 patients, including 10 with healthy retinae and 40 with non-proliferative DR. Two independent, masked graders quantified hypoperfusion in each image using two methods: freehand annotation and a new Michigan grid method. Results: Using the Michigan grid method, Grader 1 identified more ungradable segments, while Grader 2 identified more perfused and nonperfused segments. Cohen’s weighted kappa indicated substantial agreement, which was slightly higher for the entire retina (0.711) compared to the central retinal area (0.686). The Michigan grid method shows comparable or slightly improved inter-rater reliability compared to the freehand method. Conclusions: This study demonstrates a new Michigan grid method for the evaluation of FA for hypoperfusion while highlighting ongoing challenges in achieving consistent and objective retinal nonperfusion assessment, underscoring the need for further refinement and the potential integration of automated approaches.

Purpose: To describe a professionalism survey tool and its use to assess knowledge of medical professionalism in ophthalmology training programs in Central India.Settings and Design: Multi-center survey study.Methods: A validated 33-question, scenario-based survey addressing professionalism attributes was administered at five centers in central India. The attributes tested included “personal characteristics,” “physician–patient relationships,” “workplace practice and relationships,” and “socially responsible behaviors.” A mean attribute score (%) was calculated and compared to “gold standard” responses by a group of expert senior ophthalmologists (100% agreement for responses).Results: A total of 225 participants completed the survey; 124 residents, 47 fellows, and 54 consultants (98.4% response rate). The total mean attribute score was 80.7 ± 9.1 (min 16.67, max 100). There was variation in the mean attribute score by professionalism attribute (P< 0.001), and a trend toward higher mean attribute scores for consultants compared to trainees across all attribute groups. The scores for “personal characteristics” (93 ± 9.7) and “physician-patient relationship” (82 ± 15.8) were the highest, whereas scores for “socially responsible behaviors” (73.9 ± 18.6) and “workplace practices” were low (72 ± 13).Conclusions: There is a generally high level of professionalism knowledge among ophthalmologists in central India. The results suggest that experience does impact knowledge of professionalism. Potential for improvement in professionalism exists in around “workplace practices”, and around “socially responsible behaviors”. These findings may serve as a valuable discussion starter and teaching tool to enhance professionalism in ophthalmology training programs.

Background: Ophthalmology education is changing amidst the COVID-19 pandemic. The purpose of this study is to describe and evaluate the implementation of webinars combined with online resources for review for ophthalmology trainees. Methods: This is a single-center descriptive survey study. A validated survey tool was distributed 2 months after implementation of webinar education. The survey population comprised residents, fellows, and faculty in a Chicago ophthalmology training program.Results: Eighteen residents (100% response rate), 9 fellows (81.8% response rate) and 20 faculty members (44.4% response rate) responded to the survey. Barriers to webinar education and limitations to learning during webinars were rated as low in both groups (avg. 1.98 ± 2.04 and 2.16 ± 1.82, respectively). The educational value of the webinars was moderately well rated (avg. 7.35 ± 1.66). Interest in webinars replacing in-person lectures was neutral (avg. 5.45 ± 2.54). Faculty expressed fewer barriers (p = 0.005), and a higher preference to use webinar education frequently (p = 0.003) and instead of in-person lectures (p = 0.009), compared to trainees. Conclusions: The findings of this survey suggest that webinars in ophthalmology education are effective and feasible, with some perceived limitations.

Purpose: To elucidate the relationship between disorganization of retinal inner layers (DRILs) and retinal function in diabetic patients without diabetic retinopathy (DR) and with nonproliferative DR, but without diabetic macular edema (DME). Methods: Fifty-seven participants with diabetes mellitus (DM) and 18 healthy controls underwent comprehensive ophthalmic examination, fundus photography, and spectral-domain optical coherence tomography. Scans of the fovea were evaluated for the presence of DRIL. Retinal function was evaluated using Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, the quick contrast sensitivity function (qCSF) on the AST Sentio Platform, short-wavelength automated perimetry (SWAP), standard automated perimetry (SAP), and frequency doubling perimetry (FDP). ANOVA and Kruskal-Wallis were used to compare retinal function in subjects with and without DRIL. Tukey-Kramer test and Wilcoxon were used for post hoc analysis. Results: DRIL was identified in 9 of 57 diabetic subjects. DRIL subjects had higher body mass index and longer diabetes duration compared to diabetic subjects without DRIL (P = 0.03 and P = 0.009, respectively). Subjects with DRIL had reduced ETDRS visual acuity (P = 0.003), contrast sensitivity function (P = 0.0003), and SAP performance (PSD, P < 0.0001) compared to controls and diabetic subjects without DRIL. Structural analysis revealed inner retinal thinning, and some outer retinal thinning, associated with DRIL. Conclusions: Diabetic subjects with DRIL have reduced retinal function compared to those without DRIL, and defective retinal lamination may be an early cellular consequence of diabetes responsible for this in some patients. Following further longitudinal studies, DRIL may be a readily available and reliable structural biomarker for reduced retinal function in early diabetic neuroretinal disease.

Purpose: To test whether quantitative functional tests and optical coherence tomography (OCT)-defined structure can serve as effective tools to diagnose and monitor early diabetic neuroretinal disease. Methods: Fifty-seven subjects with diabetes (23 without diabetic retinopathy [no DR], 19 with mild nonproliferative diabetic retinopathy [mild NPDR], 15 with moderate to severe [moderate NPDR]), and 18 controls underwent full ophthalmic examination, fundus photography, spectral-domain optical coherence tomography (SD-OCT), e-ETDRS (Early Treatment Diabetic Retinopathy Study) acuity, and the quick contrast sensitivity function (qCSF) method. Perimetry testing included short-wavelength automated perimetry (SWAP), standard automated perimetry (SAP), frequency doubling perimetry (FDP), and rarebit perimetry (RBP). Results: ETDRS acuity and RBP were not sensitive for functional differences among subjects with diabetes. AULCSF, a metric of qCSF, was reduced in diabetics with moderate compared to mild NPDR (P = 0.03), and in subjects with no DR compared to controls (P = 0.04). SWAP and SAP mean deviation (MD) and foveal threshold (FT) were reduced in moderate compared to mild NPDR (SWAP, MD P = 0.002, FT P = 0.0006; SAP, MD P = 0.02, FT P = 0.007). FDP 10-2 showed reduced MD in moderate compared to mild NPDR (P = 0.02), and FDP 24-2 revealed reduced pattern standard deviation (PSD) in mild NPDR compared to no DR (P = 0.02). Structural analysis revealed thinning of the ganglion cell layer and inner plexiform layer (GCL+IPL) of moderate NPDR subjects compared to controls. The thinner GCL+IPL correlated with impaired retinal function. Conclusions: This multimodal testing analysis reveals insights into disruption of the neuroretina in diabetes and may accelerate the testing of novel therapies.