The subsequent impact of introducing meeting-free days was profound, as outlined in the table below. When one no-meeting day per week was introduced, autonomy, communication, engagement, and satisfaction all improved, resulting in decreased micromanagement and stress, which caused productivity to rise.
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Unwanted optical images are a leading cause of patient dissatisfaction after uncomplicated cataract surgery. This includes dysphotopsias, or undesirable optical patterns on the retina. Positive dysphotopsia (PD) is a bright artifact of light, described as arcs, streaks, starbursts, rings, or halos occurring centrally or mid-peripherally. Negative dysphotopsia (ND) is the absence of light on a portion of the retina described as a dark, temporal arcing shadow. The exact nature of these events is incompletely understood, but there are many different theories with both clinical and laboratory evidence to support them. At present, it seems that PD is related to intraocular lens (IOL) material, design, and location, while ND is multifactorial in origin, primarily contributing to an illumination gap causing a shadow on the retina. ND is more complex to analyze but may benefit from improved IOL design as well as varying the surgical approach of IOL implantation. While most patient experiences of dysphotopsia resolve or undergo neuroadaptation, persistent symptoms can occur and warrant surgical consideration.
Eliciting a good history is crucial in the diagnosis of dysphotopsia. Following CE/IOL, knowledge of the specific IOL manufacturer and lens type is important. Additionally, a detailed subjective examination includes any patient experience of bright artifacts of light described as arcs, streaks, starbursts, rings, or halos. Experiences of dark, temporal arcing shadows or curtains should also be discussed. If the patient is experiencing any of the following symptoms, attention to detail should focus on onset, location of the dysphotopsia in the visual field, characteristics, precipitating/alleviating factors, and severity of impairment on visual quality and activities of daily living. Reassurance and validation of the patient's symptoms are important.
Positive dysphotopsia typically presents with bright artifacts of light described as arcs, streaks, starbursts, rings, or halos. Negative dysphotopsia typically presents as dark, temporal arcing shadows or curtains.[1]
Conservative management is the primary nonsurgical approach as most of these symptoms diminish within a matter of weeks. Pharmacologic miosis with drops such as pilocarpine and brimonidine can help relieve PD, especially at nighttime, but does little for ND symptoms. Spectacles with a thick frame, even if not visually necessary, can help with ND as the brain attributes the shadow to the frames. Additionally, management should address other confounding visual complaints through correction of any refractive error, treatment of any coexisting ocular surface disease such as dry eye, and cautious treatment of PCO if IOL exchange is not required or expected in the future.[1]
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