We thank our partners, the Cochrane Eyes and Vision US Satellite (CEV@US), for identifying reliable systematic reviews that we cite and discuss in support of the PPP recommendations.The Preferred Practice Patterns Committee members reviewed and discussed the document during a meeting in June 2021. The document was edited in response to the discussion and comments.

<H4>BACKGROUND AND OBJECTIVE</H4> <P> The Accreditation Council for Graduate Medical Education (ACGME) has mandated implementation of six new competencies in resident training in the United States. An implementation strategy is proposed to teach and assess cataract surgical competence. </P> <H4>PATIENTS AND METHODS</H4> <P> An intradepartmental Task Force for the ACGME competencies reviewed the literature for assessment tools to develop an implementation matrix for assessing surgical competence. </P> <H4>RESULTS</H4> <P> “Good practices” (gleaned from the literature) were adapted for the institution’s needs and tested, including (1) written and explicit goals or objectives for each stage of training; (2) substitution of a criterion-referenced (Dreyfus model) scoring rubric for a norm-referenced, peer-benchmarked global evaluation; (3) use of formative rather than summative feedback; (4) incorporation of deliberate practice (Ericsson model); and (5) portfolio-based documentation of sentinel event markers and remediation. </P> <H4>CONCLUSION </H4> <P>An implementation matrix for teaching and assessing surgical competence might be useful for local compliance with the ACGME mandate. </P> <P>[<CITE>Ophthalmic Surg Lasers Imaging</CITE> 2006;37:384-393.] </P> <H4>AUTHORS</H4> <P>From the Departments of Ophthalmology (TAO, AGL, HAB, ATJ, HCB, RO, KC), Neurology (AGL), Neurosurgery (AGL), and Otolaryngology (KC), University of Iowa Hospital and Clinics and University of Iowa Carver College of Medicine; and the Veterans Affairs Medical Center (TAO), Iowa City, Iowa. </P> <P>Accepted for publication May 24, 2006. </P> <P>Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York. </P> <P>Presented in part at the annual meeting of the American Academy of Ophthalmology, Chicago, Illinois, October 14-19, 2005; and the American Society of Cataract and Refractive Surgery, San Francisco, California, March 22, 2006. </P> <P>Address reprint requests to Andrew G. Lee, MD, Department of Ophthalmology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive PFP, Iowa City, IA 52242. </P>

Diabetes mellitus is a multiorgan systemic disease impacting numerous ocular structures that results in significant ocular morbidity and often results in more frequent corneal and glaucoma surgeries for affected individuals. We hypothesize that the systemic metabolic and proteomic derangement observed in the progression of diabetes influences the composition of the aqueous humor (AH), which ultimately impacts the anterior segment health of the eye. To identify changes associated with diabetes progression, we mapped the metabolite profile and proteome of AH samples from patients with varying severities of type II diabetes (T2DM). Patients were classified as nondiabetic (ND or control), non-insulin-dependent diabetic without advanced features of disease (NAD-ni), insulin-dependent diabetic without advanced features (NAD-i), or diabetic with advanced features (AD). AH samples collected from the anterior chamber during elective ophthalmic surgery were evaluated for metabolite and protein expression changes associated with diabetic severity via gas chromatography/mass spectrometry and ultra-high performance liquid chromatography tandem mass spectrometry, respectively. Metabolic and proteomic pathway analyses were conducted utilizing MetaboAnalyst 4.0 and Ingenuity Pathway Analysis. A total of 14 control, 12 NAD-ni, 4 NAD-I, and 14 AD samples were included for analysis. Elevated levels of several branched amino acids (e.g., valine, leucine, isoleucine), and lipid metabolites (e.g., palmitate) were found only with increasing diabetic severity (i.e., the AD group). Similar proteomic trends were noted in amino acid and fatty acid metabolism and the unfolded protein/stress response. These results represent the first report of both metabolomic and proteomic evaluation of aqueous humor. Diabetes results in metabolic and proteomic perturbations detectable in the AH, and unique changes become manifest as T2DM severity worsens. Changes in AH composition may serve as an indicator of disease severity, risk assessment of anterior segment cells and structures, and potential future therapies.