January 2015
77
Letters to the Editor
1. Bandhu SD, Raje S. Experiences with E‑learning in ophthalmology. Indian J Ophthalmol 2014;62:792‑4. 2. Bullough RV Jr. Ethical and moral matters in teaching and teacher education. Teach Teach Educ 2001,2011;27:21e‑8. 3. Buzzelli C, Johnston B. Authority, power, and morality in classroom discourse. Teach Teach Educ 2001;17:873e‑4. 4. Colnerud G. Ethical conflicts in teaching. Teach Teach Educ 1997;13:627e‑35. Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/0301-4738.151485 PMID: ***
References 1. Bandhu SD, Raje S. Experiences with E‑learning in ophthalmology. Indian J Ophthalmol 2014;62:792‑4. 2. Bullough RV Jr. Ethical and moral matters in teaching and teacher education. Teach Teach Educ 2011;27:21‑8. 3. Buzzelli C, Johnston B. Authority, power, and morality in classroom discourse. Teach Teach Educ 2001;17:873‑84. 4. Barrow R. Is teaching an essentially moral enterprise? Teach Teach Educ 1992;8:105‑8. 5. Chodorow S. Educators must take the electronic revolution seriously. Acad Med 1996;71:221‑6. Access this article online Quick Response Code: Website: www.ijo.in
Author's reply Dear Editor, It is a matter of fact that in majority of classrooms, the teacher possesses authority, both in terms of having the power to direct the classroom activities and in the sense of having the knowledge that the students need to acquire.[1,2] Morality and power are inherent in the exercise of this authority. In fact, the process of education is fundamentally moral in nature. From the teacher’s point of view, teaching involves constant and complex moral decision‑making.[3] However, the fact is that it is the ability to communicate worthwhile understanding rather than his or her moral integrity or the nature of his or her personal interactions that lies at the heart of teaching.[4] A simplistic view sees this teacher power as a bad thing. Over the last few years, there have been efforts to minimize the role of authority in the process of teaching.[3] E‑learning is, in fact, a step toward more independent and active learning. The teacher devolves responsibility to students, giving them responsibility to participate effectively. Learners have control over the content, learning sequence and pace of learning allowing the learners to meet their personal learning objectives be it to gain knowledge or to pass examinations with ease.[5]
Comment on Comparison of ocular response analyzer parameters in primary open angle glaucoma and exfoliative glaucoma patients Sir, Recently, Beyazyıldız et al.[1] investigated ocular response analyzer (ORA) parameters in primary open angle glaucoma (POAG), exfoliative glaucoma (EXG) patients and control subjects. We congratulate the authors that they found impressive results with such a simple‑design study. The authors found (i) significantly lower corneal hysteresis (CH) and corneal resistance factor (CRF) in EXG patients than other groups, (ii) insignificant difference in CRF between POAG and control subjects, (iii) significant positive correlation between CH and central corneal thickness in EXG patients and control subject but not in POAG patients.
Seema Dutt Bandhu, Swati Raje
The results really have clinical significance in terms of diagnosis and management. However, we wander whether the authors performed adjustments for multiple comparisons in the statistical analyses. We also wander about the relation between functional parameters and ORA results. Are visual field losses in the groups related with CH and CRF? Does lower CH result in higher mean deviation values despite normal intraocular pressure? What is the correlation between CH/CRF and visual field parameters? The answers of these questions are very important and will increase our understanding about the progression of glaucoma in POAG and EXG patients. We kindly ask to the authors about the answers of these questions.
Department of Ophthalmology and Community Medicine, MIMER Medical College, Talegaon Dabhade, Pune, Maharashtra, India
Fatih C Gundogan, Abdullah İlhan1, Umit Yolcu2
Correspondence to: Dr. Seema Dutt Bandhu, 118, Tulip, Parmar Garden, Wanowrie, Pune ‑ 411 040, Maharashtra, India. E‑mail: [email protected]
Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, 1Erzurum Military Hospital, Ophthalmology Service, Erzurum, 2 Sarıkamış Military Hospital, Ophthalmology Service, Kars, Turkey
In this study, the feedback was taken after the students had completed their term in Ophthalmology and were in the eighth term, so there was no reason for response bias and hence the need for blinding was not felt. The fact that an educational campus is Wi‑Fi enabled implies that the management encourages the use of the internet for the purpose of education. In this sense, the study was supported by the management in every way technical, financial and administrative apart from ethical clearance.
78
Indian Journal of Ophthalmology Correspondence to: Dr. Fatih C Gundogan, Yayla Mah, Bağcı Cad, 1392 Sok, No: 4/9 Etlik-Keçiören, 06018 Etlik-Ankara, Turkey. E‑mail: [email protected]
Reference 1. Beyazyildiz E, Beyazyildiz O, Arifoglu HB, Altintas AK, Köklü SG. Comparison of ocular response analyzer parameters in primary open angle glaucoma and exfoliative glaucoma patients. Indian J Ophthalmol 2014;62:782‑7.
Vol. 63 No. 1
adjusting only for age, intraocular pressure or any ocular response analyzer measure would not be enough because CH is affected by many ocular and systemic factors. We did not made any adjustments for multiple comparison of corneal biomechanical properties in statistical analysis of this study. We appreciate the opportunity given to us by the editor and authors and we hope these replies will help the understanding of corneal biomechanical properties in EXG eyes or other types of glaucoma and encourage researchers for longitudinal prospective studies with larger study groups.
Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/0301-4738.151489 PMID: ***
Author's reply Dear Sir, We thank the authors for their interest to our article.[1] In our study we have demonstrated that exfoliative glaucoma (EXG) patients have lower corneal hysteresis (CH) levels and at this point we have hypothesized that this lower CH levels may be a reason for rapid progression in visual deterioration in EXG patients. The authors asked for correlations between visual field test (mean deviation [MD]) and corneal biomechanical properties. We did not correlate visual field parameters with corneal biochemical properties in our study. As we have stated, our study is cross‑sectional observational study. We thought that simply comparison of MD value of the visual field with corneal biomechanical properties may not be relevant. Because visual field test is a dynamic test and may be affected by several factors.[2] MD could be affected by refraction errors, small pupils and hazy media.[3‑5] We know that patients with EXG have smaller pupil diameter and a higher incidence of lenticular opasification.[6] In order to find and observe a correlation between visual field parameters and corneal biochemical parameters, researchers should start a prospective study and should actively observe changes in visual field parameters in patients with lower CH and show correlation between CH and visual field deterioration. As we have stated in our study, there is a need for longitudinal prospective studies to show changes in visual field defects relative to baseline levels in patients with different corneal biomechanical properties to prove that lower CH is associated with a more rapid progression of optic neuropathy in eyes with EXG. Authors asked for whether any adjustment performed for multiple comparisons. There are many factors affecting CH, apart from our study findings, such as axial length, age, corneal curvature, corneal disease, etc.[7‑8] In our study, age was significantly different between groups. As we have stated in the discussion section of the manuscript, this factor may be a limitation for our study. But comparison of parameters
Emrullah Beyazyıldız, Özlem Beyazyıldız1, Hasan Basri Arifoğlu2, Ayşegül Koçak Altıntaş1, Şükrü Gültekin Köklü1 Department of Ophthalmology, Gazi Mustafa Kemal Government Hospital, 1Department of Ophthalmology, Ulucanlar Eye Research and Training Hospital, Ankara, 2Department of Ophthalmology, Kaçkar Government Hospital, Rize, Turkey Correspondence to: Dr. Emrullah Beyazyıldız, Gazi Mustafa Kemal Devlet Hastenesi, Silahtar Caddesi No: 2, Gazi Mahallesi, Yenimahalle, Ankara, Turkey. E‑mail: [email protected]
References 1. Beyazyildiz E, Beyazyildiz O, Arifoglu HB, Altintas AK, Köklü SG. Comparison of ocular response analyzer parameters in primary open angle glaucoma and exfoliative glaucoma patients. Indian J Ophthalmol 2014;62:782‑7. 2. Prata TS, De Moraes CG, Teng CC, Tello C, Ritch R, Liebmann JM. Factors affecting rates of visual field progression in glaucoma patients with optic disc hemorrhage. Ophthalmology 2010;117:24‑9. 3. Herse PR. Factors influencing normal perimetric thresholds obtained using the Humphrey Field Analyzer. Invest Ophthalmol Vis Sci 1992;33:611‑7. 4. Koller G, Haas A, Zulauf M, Koerner F, Mojon D. Influence of refractive correction on peripheral visual field in static perimetry. Graefes Arch Clin Exp Ophthalmol 2001;239:759‑62. 5. Congdon NG, Quigley HA, Hung PT, Wang TH, Ho TC, Glovinsky Y. Impact of age, various forms of cataract, and visual acuity on whole‑field scotopic sensitivity screening for glaucoma in rural Taiwan. Arch Ophthalmol 1995;113:1138‑43. 6. Drolsum L, Ringvold A, Nicolaissen B. Cataract and glaucoma surgery in pseudoexfoliation syndrome: A review. Acta Ophthalmol Scand 2007;85:810‑21. 7. Sullivan‑Mee M, Katiyar S, Pensyl D, Halverson KD, Qualls C. Relative importance of factors affecting corneal hysteresis measurement. Optom Vis Sci 2012;89:E803‑11. 8. Goldich Y, Barkana Y, Pras E, Fish A, Mandel Y, Hirsh A, et al. Variations in corneal biomechanical parameters and central corneal thickness during the menstrual cycle. J Cataract Refract Surg 2011;37:1507‑11. Access this article online Quick Response Code: Website: www.ijo.in
Copyright of Indian Journal of Ophthalmology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
77
Letters to the Editor
1. Bandhu SD, Raje S. Experiences with E‑learning in ophthalmology. Indian J Ophthalmol 2014;62:792‑4. 2. Bullough RV Jr. Ethical and moral matters in teaching and teacher education. Teach Teach Educ 2001,2011;27:21e‑8. 3. Buzzelli C, Johnston B. Authority, power, and morality in classroom discourse. Teach Teach Educ 2001;17:873e‑4. 4. Colnerud G. Ethical conflicts in teaching. Teach Teach Educ 1997;13:627e‑35. Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/0301-4738.151485 PMID: ***
References 1. Bandhu SD, Raje S. Experiences with E‑learning in ophthalmology. Indian J Ophthalmol 2014;62:792‑4. 2. Bullough RV Jr. Ethical and moral matters in teaching and teacher education. Teach Teach Educ 2011;27:21‑8. 3. Buzzelli C, Johnston B. Authority, power, and morality in classroom discourse. Teach Teach Educ 2001;17:873‑84. 4. Barrow R. Is teaching an essentially moral enterprise? Teach Teach Educ 1992;8:105‑8. 5. Chodorow S. Educators must take the electronic revolution seriously. Acad Med 1996;71:221‑6. Access this article online Quick Response Code: Website: www.ijo.in
Author's reply Dear Editor, It is a matter of fact that in majority of classrooms, the teacher possesses authority, both in terms of having the power to direct the classroom activities and in the sense of having the knowledge that the students need to acquire.[1,2] Morality and power are inherent in the exercise of this authority. In fact, the process of education is fundamentally moral in nature. From the teacher’s point of view, teaching involves constant and complex moral decision‑making.[3] However, the fact is that it is the ability to communicate worthwhile understanding rather than his or her moral integrity or the nature of his or her personal interactions that lies at the heart of teaching.[4] A simplistic view sees this teacher power as a bad thing. Over the last few years, there have been efforts to minimize the role of authority in the process of teaching.[3] E‑learning is, in fact, a step toward more independent and active learning. The teacher devolves responsibility to students, giving them responsibility to participate effectively. Learners have control over the content, learning sequence and pace of learning allowing the learners to meet their personal learning objectives be it to gain knowledge or to pass examinations with ease.[5]
Comment on Comparison of ocular response analyzer parameters in primary open angle glaucoma and exfoliative glaucoma patients Sir, Recently, Beyazyıldız et al.[1] investigated ocular response analyzer (ORA) parameters in primary open angle glaucoma (POAG), exfoliative glaucoma (EXG) patients and control subjects. We congratulate the authors that they found impressive results with such a simple‑design study. The authors found (i) significantly lower corneal hysteresis (CH) and corneal resistance factor (CRF) in EXG patients than other groups, (ii) insignificant difference in CRF between POAG and control subjects, (iii) significant positive correlation between CH and central corneal thickness in EXG patients and control subject but not in POAG patients.
Seema Dutt Bandhu, Swati Raje
The results really have clinical significance in terms of diagnosis and management. However, we wander whether the authors performed adjustments for multiple comparisons in the statistical analyses. We also wander about the relation between functional parameters and ORA results. Are visual field losses in the groups related with CH and CRF? Does lower CH result in higher mean deviation values despite normal intraocular pressure? What is the correlation between CH/CRF and visual field parameters? The answers of these questions are very important and will increase our understanding about the progression of glaucoma in POAG and EXG patients. We kindly ask to the authors about the answers of these questions.
Department of Ophthalmology and Community Medicine, MIMER Medical College, Talegaon Dabhade, Pune, Maharashtra, India
Fatih C Gundogan, Abdullah İlhan1, Umit Yolcu2
Correspondence to: Dr. Seema Dutt Bandhu, 118, Tulip, Parmar Garden, Wanowrie, Pune ‑ 411 040, Maharashtra, India. E‑mail: [email protected]
Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, 1Erzurum Military Hospital, Ophthalmology Service, Erzurum, 2 Sarıkamış Military Hospital, Ophthalmology Service, Kars, Turkey
In this study, the feedback was taken after the students had completed their term in Ophthalmology and were in the eighth term, so there was no reason for response bias and hence the need for blinding was not felt. The fact that an educational campus is Wi‑Fi enabled implies that the management encourages the use of the internet for the purpose of education. In this sense, the study was supported by the management in every way technical, financial and administrative apart from ethical clearance.
78
Indian Journal of Ophthalmology Correspondence to: Dr. Fatih C Gundogan, Yayla Mah, Bağcı Cad, 1392 Sok, No: 4/9 Etlik-Keçiören, 06018 Etlik-Ankara, Turkey. E‑mail: [email protected]
Reference 1. Beyazyildiz E, Beyazyildiz O, Arifoglu HB, Altintas AK, Köklü SG. Comparison of ocular response analyzer parameters in primary open angle glaucoma and exfoliative glaucoma patients. Indian J Ophthalmol 2014;62:782‑7.
Vol. 63 No. 1
adjusting only for age, intraocular pressure or any ocular response analyzer measure would not be enough because CH is affected by many ocular and systemic factors. We did not made any adjustments for multiple comparison of corneal biomechanical properties in statistical analysis of this study. We appreciate the opportunity given to us by the editor and authors and we hope these replies will help the understanding of corneal biomechanical properties in EXG eyes or other types of glaucoma and encourage researchers for longitudinal prospective studies with larger study groups.
Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/0301-4738.151489 PMID: ***
Author's reply Dear Sir, We thank the authors for their interest to our article.[1] In our study we have demonstrated that exfoliative glaucoma (EXG) patients have lower corneal hysteresis (CH) levels and at this point we have hypothesized that this lower CH levels may be a reason for rapid progression in visual deterioration in EXG patients. The authors asked for correlations between visual field test (mean deviation [MD]) and corneal biomechanical properties. We did not correlate visual field parameters with corneal biochemical properties in our study. As we have stated, our study is cross‑sectional observational study. We thought that simply comparison of MD value of the visual field with corneal biomechanical properties may not be relevant. Because visual field test is a dynamic test and may be affected by several factors.[2] MD could be affected by refraction errors, small pupils and hazy media.[3‑5] We know that patients with EXG have smaller pupil diameter and a higher incidence of lenticular opasification.[6] In order to find and observe a correlation between visual field parameters and corneal biochemical parameters, researchers should start a prospective study and should actively observe changes in visual field parameters in patients with lower CH and show correlation between CH and visual field deterioration. As we have stated in our study, there is a need for longitudinal prospective studies to show changes in visual field defects relative to baseline levels in patients with different corneal biomechanical properties to prove that lower CH is associated with a more rapid progression of optic neuropathy in eyes with EXG. Authors asked for whether any adjustment performed for multiple comparisons. There are many factors affecting CH, apart from our study findings, such as axial length, age, corneal curvature, corneal disease, etc.[7‑8] In our study, age was significantly different between groups. As we have stated in the discussion section of the manuscript, this factor may be a limitation for our study. But comparison of parameters
Emrullah Beyazyıldız, Özlem Beyazyıldız1, Hasan Basri Arifoğlu2, Ayşegül Koçak Altıntaş1, Şükrü Gültekin Köklü1 Department of Ophthalmology, Gazi Mustafa Kemal Government Hospital, 1Department of Ophthalmology, Ulucanlar Eye Research and Training Hospital, Ankara, 2Department of Ophthalmology, Kaçkar Government Hospital, Rize, Turkey Correspondence to: Dr. Emrullah Beyazyıldız, Gazi Mustafa Kemal Devlet Hastenesi, Silahtar Caddesi No: 2, Gazi Mahallesi, Yenimahalle, Ankara, Turkey. E‑mail: [email protected]
References 1. Beyazyildiz E, Beyazyildiz O, Arifoglu HB, Altintas AK, Köklü SG. Comparison of ocular response analyzer parameters in primary open angle glaucoma and exfoliative glaucoma patients. Indian J Ophthalmol 2014;62:782‑7. 2. Prata TS, De Moraes CG, Teng CC, Tello C, Ritch R, Liebmann JM. Factors affecting rates of visual field progression in glaucoma patients with optic disc hemorrhage. Ophthalmology 2010;117:24‑9. 3. Herse PR. Factors influencing normal perimetric thresholds obtained using the Humphrey Field Analyzer. Invest Ophthalmol Vis Sci 1992;33:611‑7. 4. Koller G, Haas A, Zulauf M, Koerner F, Mojon D. Influence of refractive correction on peripheral visual field in static perimetry. Graefes Arch Clin Exp Ophthalmol 2001;239:759‑62. 5. Congdon NG, Quigley HA, Hung PT, Wang TH, Ho TC, Glovinsky Y. Impact of age, various forms of cataract, and visual acuity on whole‑field scotopic sensitivity screening for glaucoma in rural Taiwan. Arch Ophthalmol 1995;113:1138‑43. 6. Drolsum L, Ringvold A, Nicolaissen B. Cataract and glaucoma surgery in pseudoexfoliation syndrome: A review. Acta Ophthalmol Scand 2007;85:810‑21. 7. Sullivan‑Mee M, Katiyar S, Pensyl D, Halverson KD, Qualls C. Relative importance of factors affecting corneal hysteresis measurement. Optom Vis Sci 2012;89:E803‑11. 8. Goldich Y, Barkana Y, Pras E, Fish A, Mandel Y, Hirsh A, et al. Variations in corneal biomechanical parameters and central corneal thickness during the menstrual cycle. J Cataract Refract Surg 2011;37:1507‑11. Access this article online Quick Response Code: Website: www.ijo.in
Copyright of Indian Journal of Ophthalmology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
