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Baffour-Awuah KA, Taylor LJ, Josan AS, Jolly JK, MacLaren RE. Investigating the impact of asymmetric macular sensitivity on visual acuity chart reading in choroideraemia. Ophthalmic Physiol Opt 2024. [PMID: 38989810 DOI: 10.1111/opo.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Degeneration in choroideraemia, unlike typical centripetal photoreceptor degenerations, is centred temporal to the fovea. Once the fovea is affected, the nasal visual field (temporal retina) is relatively spared, and the preferred retinal locus shifts temporally. Therefore, when reading left to right, only the right eye reads into a scotoma. We investigate how this unique property affects the ability to read an eye chart. METHODS Standard- and low-luminance visual acuity (VA) for right and left eyes were measured with the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart. Letters in each line were labelled by column position. The numbers of letter errors for each position across the whole chart were summed to produce total column error scores for each participant. Macular sensitivity was assessed using microperimetry. Central sensitivity asymmetry was determined by the temporal-versus-nasal central macular difference and subsequently correlated to a weighted ETDRS column error score. Healthy volunteers and participants with X-linked retinitis pigmentosa GTPase regulator associated retinitis pigmentosa (RPGR-RP) were used as controls. RESULTS Thirty-nine choroideraemia participants (median age 44.9 years [IQR 35.7-53.5]), 23 RPGR-RP participants (median age 30.8 years [IQR 26.5-40.5]) and 35 healthy controls (median age 23.8 years [IQR 20.3-29.0]) were examined. In choroideraemia, standard VA in the right eye showed significantly greater ETDRS column errors on the temporal side compared with the nasal side (p = 0.002). This significantly correlated with greater asymmetry in temporal-versus-nasal central macular sensitivity (p = 0.04). No significant patterns in ETDRS column errors or central macular sensitivity were seen in the choroideraemia left eyes, nor in RPGR-RP and control eyes. CONCLUSION Difficulty in tracking across lines during ETDRS VA testing may cause excess errors independent of true VA. VA assessment with single-letter optotype systems may be more suitable, particularly for patients with choroideraemia, and potentially other retinal diseases with asymmetric central macular sensitivity or large central scotomas including geographic atrophy.
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Affiliation(s)
- Kwame A Baffour-Awuah
- Oxford Eye Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Laura J Taylor
- Oxford Eye Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Amandeep S Josan
- Oxford Eye Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jasleen K Jolly
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
| | - Robert E MacLaren
- Oxford Eye Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Victor AA, Andayani G, Djatikusumo A, Yudantha AR, Hutapea MM, Gunardi TH, Soetjoadi H. Efficacy of Prophylactic Anti-VEGF in Preventing Radiation Retinopathy: A Systematic Review and Meta-Analysis. Clin Ophthalmol 2023; 17:2997-3009. [PMID: 37850047 PMCID: PMC10577260 DOI: 10.2147/opth.s433531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
Background In patients predisposed to radiation retinopathy (RR), administration of therapy after apparent clinical signs and symptoms are considered too late, resulting in substantial vision loss and blindness. Early initiation of anti-vascular endothelial growth factor (anti-VEGF) might serve as a strategy to slow disease progression and prolong good eyesight. Objective To evaluate the efficacy of prophylactic anti-VEGF in preventing RR and preserving vision in patients at high risk of radiation-induced vision loss. Methods A systematic literature search was performed from inception to 4 June 2023 using Cochrane Library, EMBASE, PubMed (MEDLINE), and Scopus. Eligible studies were clinical trials and observational studies investigating the incidence of radiation maculopathy (RM), radiation optic neuropathy (RON), moderate vision loss (loss of more than or equal to 3 lines of baseline visual acuity [VA]) and final VA, whether good (20/40 or better) or poor (20/200 or worse), following prophylactic anti-VEGF. Three reviewers independently conducted article screening, data extraction and risk of bias assessment. Random effects models were used to determine the cumulative effects of each outcome. Results Four studies (one clinical trial and three observational studies), involving 2109 patients, were included in our analysis. Across all studies, there were significant reductions in the events of RM (pooled odds ratio [OR] 0.50; 95% CI, 0.34-0.74; p = 0.001), RON (pooled OR 0.62; 95% CI, 0.42-0.90; p = 0.012) and poor final VA (pooled OR 0.50; 95% CI, 0.37-0.68; p = 0.003). The association of moderate vision loss and good final VA with the use of prophylactic anti-VEGF between the groups was unclear owing to the high level of heterogeneity. Conclusion Prophylactic anti-VEGF therapy might delay RM and RON, preventing high-risk patients from developing poor VA by approximately 50%. However, this evidence should be interpreted with caution because of its low level of certainty. Future robust studies are warranted to confirm this finding.
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Affiliation(s)
- Andi Arus Victor
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Gitalisa Andayani
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Ari Djatikusumo
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Anggun Rama Yudantha
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Mario Marbungaran Hutapea
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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Mehta J, Czanner G, Harding S, Newsham D, Robinson J. Visual risk factors for falls in older adults: a case-control study. BMC Geriatr 2022; 22:134. [PMID: 35177024 PMCID: PMC8855581 DOI: 10.1186/s12877-022-02784-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Falls are the second leading cause of accidental deaths worldwide mainly in older people. Older people have poor vision and published evidence suggests that it is a risk factor for falls. Less than half of falls clinics assess vision as part of the multi-factorial assessment of older adults at risk of falls despite vision being an essential input for postural stability. The aim of our study was to investigate the relationship between all clinically assessed visual functions and falls amongst older adults in a prospective observational individually age-matched case control study. Methods Visual acuity (VA), contrast sensitivity (CS), depth perception, binocular vision and binocular visual field were measured using routinely used clinical methods in falls participants (N = 83) and non-falls participants (N = 83). Data were also collected on socio-demographic factors, general health, number of medications, health quality, fear of falling and physical activity. Logistic regression analysis was carried out to determine key visual and non-visual risk factors for falls whilst adjusting for confounding covariates. Results Older adults have an increased risk of experiencing a fall if they have reduced visual function (odds ratio (OR): 3.49, 1.64-7.45, p = 0.001), specifically impaired stereoacuity worse than 85” of arc (OR: 3.4, 1.20-9.69, p = 0.02) and reduced (by 0.15 log unit) high spatial frequency CS (18 cpd) (OR:1.40, 1.12-1.80, p = 0.003). Older adults with a hearing impairment are also at higher risk of falls (OR: 3.18, 95% CI: 1.36-7.40, p = 0.007). The risk decreases with living in a less deprived area (OR: 0.74, 0.64-0.86, <0.001), or socialising more out of the home (OR: 0.75, 0.60-0.93, p = 0.01). Conclusions The combination of social, behavioural and biological determinants are significant predictors of a fall. The non-visual risk factors include older adults, living in deprived neighbourhoods, socialising less outside of the home and those who have a hearing impairment. Impaired functional visual measures; depth perception and contrast are significant visual risk factors for falls above visual acuity.
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Affiliation(s)
- Jignasa Mehta
- School of Health Sciences, Institute of Population Health, University of Liverpool, Thompson Yates Building, L69 3GB, Liverpool, UK.
| | - Gabriela Czanner
- School of Computer Science and Mathematics, Faculty of Engineering and Technology, Liverpool John Moores University, Liverpool, UK.,Faculty of Informatics and Information Technology, Slovak University of Technology, Bratislava, Slovakia
| | - Simon Harding
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,St. Pauls Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - David Newsham
- School of Health Sciences, Institute of Population Health, University of Liverpool, Thompson Yates Building, L69 3GB, Liverpool, UK
| | - Jude Robinson
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
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Exploring factors predicting changes in patients' expectations and psychosocial issues during the course of treatment with intravitreal injections for wet age-related macular degeneration. Eye (Lond) 2017; 32:673-678. [PMID: 29219960 DOI: 10.1038/eye.2017.271] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/22/2017] [Indexed: 11/08/2022] Open
Abstract
PurposePatients with wet age-related macular degeneration (AMD) often require long courses of treatment. We investigate the psychosocial issues that could hinder compliance, including patient expectations of treatment. The aims of this study were to explore the factors related to changes in patient expectations, pain, and anxiety during treatment.Patients and methodsA structured interview was carried out among 50 patients selected from the list attending the AMD unit at the Princess Alexandra Eye Pavilion (PAEP). The interview was based on a questionnaire. Additionally, a visual analogue scale was created as a tool for measuring patient expectations, pain, and anxiety. Data were analysed using multinomial regression analysis.ResultsThere were significantly more patients who had a fall in expectations (P<0.05) during the course of treatment. A fall in expectations was found to be predicted by higher starting expectations (P=0.00001), greater decline in visual acuity (P=0.008), and perceived deterioration of vision after starting treatment (P=0.013). Of the patients, 32% planned to stop attending for further injections. Planning to stop attending was correlated with worse final visual acuity (P=0.026, 95% CI). Pain and anxiety with intravitreal therapy (IVT) was significantly reduced when patients were accompanied to the clinic by a friend or relative (P<0.01) using Pearson's correlation (r=0.597).ConclusionPatients require appropriate counselling at the start of a course of treatment to align expectations with perceived treatment outcomes in order to improve adherence. Additionally, a large minority of patients would consider stopping treatment. Patients' expectations should be assessed at relevant time points along a course of treatment.
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Millard JD, Muhangi L, Sewankambo M, Ndibazza J, Elliott AM, Webb EL. Assessing the external validity of a randomized controlled trial of anthelminthics in mothers and their children in Entebbe, Uganda. Trials 2014; 15:310. [PMID: 25100338 PMCID: PMC4138365 DOI: 10.1186/1745-6215-15-310] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 07/18/2014] [Indexed: 12/29/2022] Open
Abstract
Background The ‘external validity’ of randomized controlled trials is an important measure of quality, but is often not formally assessed. Trials concerning mass drug administration for helminth control are likely to guide public health policy and careful interpretation of their context is needed. We aimed to determine how representative participants in one such trial were of their community. We explore implications for trial interpretation and resulting public health recommendations. Methods The trial assessed was the Entebbe Mother and Baby Study (EMaBS), a trial of anthelminthic treatment during pregnancy and early childhood. In a novel approach for assessing external validity, we conducted a two-stage cluster sample community survey within the trial catchment area and compared characteristics of potentially-eligible community children with characteristics of children participating in the trial. Results A total of 173 children aged three to five-years-old were surveyed from 480 households. Of children surveyed, we estimated that mothers of 60% would have been eligible for recruitment, and of these, 31% had actually been enrolled. Children surveyed were compared to 199 trial children in the same age group reviewed at annual trial visits during the same time period. There were significant differences in ethnicity between the trial participants and the community children, and in socioeconomic status, with those in the trial having, on average, more educated parents and higher maternal employment. Trial children were less likely to have barefoot exposure and more likely to use insecticide-treated bed nets. There were no significant differences in numbers of reported illness events over the last year. Conclusions The trial had not enrolled all eligible participants, and those enrolled were of higher socioeconomic status, and had lower risk of exposure to the parasitic infections targeted by the trial interventions. It is possible the trial may have underestimated the absolute effects of anthelminthic treatment during pregnancy and early childhood, although the fact that there were no differences in reported incidence of common infectious diseases (one of the primary outcomes of EMaBS) between the two groups provides reassurance. Concurrent community surveys may be an effective way to test the external validity of trials. EMaBS Trial registration ISRCTN32849447, registered 22 July 2005 Electronic supplementary material The online version of this article (doi:10.1186/1745-6215-15-310) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James D Millard
- Department of Global Health, Division of Clinical Medicine, Brighton and Sussex Medical School, Falmer, Brighton BN1 9PX, UK.
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