There is much to be learned in China, but nowhere is the opportunity greater than at the Great Wall. Built and rebuilt over many centuries, the Great Wall stands as a monument to the Chinese spirit and at the same time, a tangible example of what single-minded purpose can accomplish.

Bricks, stones and packed dirt make the wall, but the common need for protection against adversaries created it. Just getting up to the wall requires considerable effort. Hauling the bricks and stones to build the hundreds of miles of wall seems incredibly impossible.

If there is one lesson we can learn from the wall, it is that mere men can build great things. That common need, especially when driven by mutual benefit, can make the impossible possible. Next week, I will share some ideas about optometry and how we can work together to build our own Great Wall.

Arthur B. Epstein, OD, FAAO Chief Medical Editor artepstein@optometricphysician.com

Want to share your perspective? Write to Dr. Epstein at artepstein@optometricphysician.com. Comments received may be published on OP-Blog at the discretion of the editor without attribution. Please indicate if you would like your thoughts attributed to you. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of the editorial board, Jobson Publishing or any other entities or individuals.

 

This investigator- and patient-masked, single-site, randomized, and prospective study involved 45 successful contact lens wearers to evaluate the safety of Systane Ultra Lubricant Eye Drops in contact lens wearers. A currently marketed contact lens rewetting drop was the control solution. Eligible subjects' baseline biomicroscopy findings, visual acuity, and corneal staining score were recorded. Subjects received either the test or control solution with masked labeling. Subjects were instructed to instill their assigned solution in both eyes: 15 minutes prior to lens insertion, at least one drop during lens wear and another drop immediately following lens removal. After 14 days, biomicroscopy results, visual acuity, and corneal staining score were recorded.

No adverse events were documented for either the test or the control solution. For subjects using Systane Ultra, no statistically significant change was detected in visual acuity or corneal staining score. For subjects using the control solution, the change in visual acuity was not clinically relevant and there was no significant change in corneal staining score.

This clinical study provided evidence of safety and compatibility of Systane Ultra Lubricant Eye Drops in contact lens wearers.

This study was designed to first evaluate the anatomic success rates of scleral buckling surgery in the treatment of rhegmatogenous retinal detachment and possible differences in outcome depending on patients' refractive error and lens status and second, to evaluate demographic characteristics of patients with retinal detachment to contribute to our knowledge of the epidemiology of this important and sight-threatening disease. The Munster Study on Therapy Achievements in Retinal Detachment (MUSTARD) is one of the largest case series of patients with retinal detachment and their outcome after buckling surgery ever established, with 4325 subjects who underwent surgery between 1980 and 2001.

The overall success rate in all 4325 MUSTARD cases was 83.98%. The highest success rate was achieved in patients aged 51 to 60 years, with 86.72%. With regard to refractive error, success rates were highest in moderate myopes, that is, in 707 patients with a refractive error between -2.75 and -8.0 D (86.70%) and in 573 patients with mild myopia between -0.5 and -2.0 D (86.21%). The lens status did not play a significant role in outcome. In patients with nontrauma-related retinal detachment, success rates were 84.45% for phakic patients, 82.88% for pseudophakic patients, and 81.88% for aphakic patients. An epidemiologically surprising result was the lower than expected number of myopic individuals among patients with retinal detachment: Only approximately one quarter had myopia of -2.75 D or more. In phakic patients aged 51 to 80 years, only 16% were myopic.

Scleral buckling is an established and generally successful method for the treatment of retinal detachment. As our case series has demonstrated, myopia, aphakia, and pseudophakia do not constitute factors that might diminish the chances of success.

Sociolinguistic analysis of videotaped community ophthalmologists encounters with patients with glaucoma before and after training were evaluated to assess communication about adherence and to determine the impact of communication skills training on physicians' approach to non-adherence. Patients in both phases and physicians in phase I knew communication was being studied but not what the focus of the study was. In phase II, physicians knew the targeted communication behaviors. The subjects included 23 ophthalmologists and 100 regularly scheduled patients with glaucoma (50 per phase). An educational program with videotaped vignettes of simulated patient encounters using audience response and role play to teach patient-centered communication skills, including a 4-step adherence assessment and the use of open-ended questions in ask-tell-ask sequences. Physician eliciting an acknowledgment of non-adherence during a clinical encounter compared with acknowledgment of non-adherence during a post-visit research interview (primary outcome), and performance of targeted communication and substantive discussion of adherence were assessed.

After intervention, physicians increased the proportion of open-ended questions (15% vs 6%) and specifically about medication taking (82% compared with 18% of encounters). Compared with the absence of ask-tell-ask communication, 32% of phase II encounters included a complete ask-tell-ask sequence, 78% included an ask-tell sequence, and 32% a tell-ask sequence. Three of 4 steps for assessment of adherence were more common in phase II, and substantial discussions of adherence occurred in 86% versus 30% of encounters. In phase II, physicians elicited acknowledgment of non-adherence in 78% (7/9) of those who acknowledged non-adherence in the post-visit interview compared with 25% in phase I (3/12).

This study demonstrates that experienced community physicians significantly improved their communication strategies and ability to detect and address non-adherence after a 3-hour educational program.