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McElhinney K, McGrath R, Holohan R, Idrees Z. Twelve-month analysis of emergency argon laser retinopexy in an Irish tertiary hospital. Ir J Med Sci 2024; 193:1653-1657. [PMID: 37874504 DOI: 10.1007/s11845-023-03549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Retinal tears occur as a result of traction at sites of retinal and vitreous adhesion-this allows retrohyaloid fluid into the subretinal space. Prompt management is required to prevent progression to rhegmatogenous retinal detachment (RRD). AIMS To identify the post-procedural outcomes following treatment of retinal tears with laser retinopexy in an emergency setting. METHODS Retrospective review of all patients who underwent emergency slit-lamp laser retinopexy between January and December 2021 in Cork University Hospital, an Irish tertiary referral centre. RESULTS A total of 87 patients were identified-mean age of 60 ± 12 years and 54% female. Follow-up ranged from 1 week to 11 months. Pre-disposing risk factors were identified-myopia (37%), recent trauma (2%), and RRD family history (5%). All patients had slit-lamp mounted laser-retinopexy performed in the eye-casualty. 63 patients (72%) had a superior break, 66 patients (76%) had a horse-shoe retinal tear, and 21 patients (24%) had a retinal hole. Associated findings included lattice degeneration (26%), sub-retinal fluid (55%), and vitreous haemorrhage (33%). Fourteen patients (16%) required multiple slit-lamp laser retinopexies while 18 patients (21%) required intervention by a vitreo-retinal surgeon including indirect-laser retinopexy (3%), cryotherapy (11%), and pars-plana vitrectomy (6%). At the most recent follow-up, all the patients had anatomically attached retinas. CONCLUSION A notable proportion of patients (21%) undergoing emergency laser retinopexy required further intervention. Patients with anteriorly located retinal tears would benefit from an early discussion with a vitreo-retinal surgeon. Departmental training in laser retinopexy and retinal tear management is recommended as part of ongoing quality improvement.
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Affiliation(s)
- Kealan McElhinney
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland.
| | - Robert McGrath
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland
| | - Rory Holohan
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland
| | - Zubair Idrees
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland
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Wilde C, Panos GD, Pooschti A, MacNab HK, Hillman JG, Vernon SA, Amoaku WM. Prevalence and Associations of Epiretinal Membranes in an Elderly English Population: The Bridlington Eye Assessment Project. J Clin Med 2024; 13:739. [PMID: 38337433 PMCID: PMC10856010 DOI: 10.3390/jcm13030739] [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: 12/25/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Purpose: To determine the prevalence and risk factors of epiretinal membranes (ERMs) in an adult English population. Methods: The Bridlington Eye Assessment Project is a population-based study of eye disease among residents aged 65 years or older. Comprehensive interviews and ophthalmic examinations were conducted to assess potential risk factors. Digital mydriatic nonstereoscopic 30° colour fundus photography (CFP) was performed. ERMs were classified as primary/idiopathic or secondary on the basis of findings from the ocular examination and the structured questionnaire. Logistic regression models were used to determine the independence of potential risk factors for idiopathic ERMs. Results: In a comprehensive screening of 3588 patients aged over 65, we identified an eye-based prevalence of ERMs of 4.26% and a subject-based prevalence of ERMs of 6.88%. The majority of these cases were idiopathic in nature (90.7%), while 9.3% were secondary ERMs; predominantly, there was a history of cataract surgery (43.5%). No significant correlation between idiopathic ERMs and factors such as age, gender, diabetes, hypertension, a history of stroke, or the presence of AMD was found. Conclusions: The prevalence of ERMs in an elderly English population and the proportion of idiopathic and secondary ERMs are similar to previous reports. However, in elderly patients aged over 65 years, age is not a risk factor for the presence of idiopathic ERMs. The presence of diabetes, hypertension, a history of stroke, and AMD of any grade was not associated with ERMs.
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Affiliation(s)
- Craig Wilde
- Division of Ophthalmology and Visual Sciences, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham NG7 2UH, UK; (C.W.); (A.P.); (S.A.V.); (W.M.A.)
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - Georgios D. Panos
- Division of Ophthalmology and Visual Sciences, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham NG7 2UH, UK; (C.W.); (A.P.); (S.A.V.); (W.M.A.)
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - Ali Pooschti
- Division of Ophthalmology and Visual Sciences, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham NG7 2UH, UK; (C.W.); (A.P.); (S.A.V.); (W.M.A.)
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | | | | | - Stephen A. Vernon
- Division of Ophthalmology and Visual Sciences, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham NG7 2UH, UK; (C.W.); (A.P.); (S.A.V.); (W.M.A.)
| | - Winfried M. Amoaku
- Division of Ophthalmology and Visual Sciences, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham NG7 2UH, UK; (C.W.); (A.P.); (S.A.V.); (W.M.A.)
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
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Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern®. Ophthalmology 2019; 127:P146-P181. [PMID: 31757500 DOI: 10.1016/j.ophtha.2019.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
| | | | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - G Atma Vemulakonda
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
| | - Gui-Shuang Ying
- Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Lesnoni G, Rossi T, Gelso A, Nistri A. Patient Satisfaction and Vision Improvement after Multiple Surgery for Recurrent Retinal Detachment. Eur J Ophthalmol 2018. [DOI: 10.1177/112067210501500116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- G. Lesnoni
- “Città di Pomezia” Polyclinic, Operative Unit of Ophthalmology
| | - T. Rossi
- ASL RM E, Ophthalmology Hospital of Roma, Operative Unit of Vitreoretinal Surgery, Roma - Italy
| | - A. Gelso
- “Città di Pomezia” Polyclinic, Operative Unit of Ophthalmology
| | - A. Nistri
- “Città di Pomezia” Polyclinic, Operative Unit of Ophthalmology
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Cheung N, Tan SP, Lee SY, Cheung GCM, Tan G, Kumar N, Cheng CY, Wong TY. Prevalence and risk factors for epiretinal membrane: the Singapore Epidemiology of Eye Disease study. Br J Ophthalmol 2016; 101:371-376. [PMID: 27343209 DOI: 10.1136/bjophthalmol-2016-308563] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/23/2016] [Accepted: 06/05/2016] [Indexed: 01/31/2023]
Abstract
AIM To examine prevalence and risk factors of epiretinal membrane (ERM) in a large, contemporary, multiethnic Asian population. METHODS Combined analysis of three population-based studies of eye diseases, with a total of 9799 Chinese, Malays and Indians residing in the general communities of Singapore. A comprehensive ophthalmic examination, interviews and laboratory blood tests were performed to assess potential risk factors. Digital retinal photographs were used to assess ERM according to a standardised protocol. ERM was classified into cellophane macular reflex (CMR) and/or preretinal macular fibrosis (PMF), and also as primary or secondary (in eyes with other retinal pathology or a history of cataract surgery). RESULTS The age-standardised and ethnicity-standardised prevalence was 12.1% for any ERM, 6.8% for CMR, 6.7% for PMF and 2.8% for bilateral ERM. ERM prevalence was higher in Chinese (13.0%) compared with Malays (7.9%) or Indians (8.7%). In multivariate analysis, significant factors associated with primary ERM were older age (OR 1.08 per year increase; p<0.01), Chinese ethnicity (OR 1.60 vs Indians; p<0.01; OR 1.39 vs Malays; p<0.01), smoking (OR 0.70; p=0.01), longer axial length (OR 1.07 per mm increase; p=0.03) and cataract (OR 0.64; p<0.01). Significant factors independently associated with secondary ERM were older age (OR 1.05; p<0.01), cataract surgery (OR 10.6; p<0.01) and diabetic retinopathy (OR 2.48; p<0.01). CONCLUSIONS ERM is common in Asians, particularly among Chinese. Older age is the most consistent risk factor for any ERM, and previous cataract surgery and diabetic retinopathy are the strongest risk factors for secondary ERM.
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Affiliation(s)
- Ning Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
| | - Shu-Pei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | | | - Gavin Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Neelam Kumar
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
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Vision-related quality of life and self-rated satisfaction outcomes of rhegmatogenous retinal detachment surgery: three-year prospective study. PLoS One 2011; 6:e28597. [PMID: 22162779 PMCID: PMC3230609 DOI: 10.1371/journal.pone.0028597] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 11/11/2011] [Indexed: 11/22/2022] Open
Abstract
Background Subjective functional outcomes measurements, such as vision health-related quality of life (VRQoL) and self-rated satisfaction measures can provide helpful multidimensional vision health information that is more comprehensive than traditional objective measures, such as best corrected visual acuity (BCVA). The purpose of this study is to demonstrate 3-year longitudinal postoperative VRQoL and self-rated satisfaction changes after rhegmatogenous retinal detachment (RRD) surgery. Methodology/Principal Findings A prospective case series report was conducted in 92 RRD patients who underwent surgery during January 2004 through December 2006. Preoperative, 3-month, 1-year and 3-year postoperative patient VRQoL and self-rated satisfaction were assessed by face-to-face interviews. The importance of objective variables for predicting three dependent variables: CLVQOL composite scores change, 3-year postoperative CVLQOL composite score and self-rated satisfaction degree scores were calculated by stepwise multivariate linear or logistic regression analysis methods. Results The total CLVQOL composite scores change ranged between -48 and 90 (mean±standard deviation: 19.48±31.34), including positive changes in 62 patients. The self-rated satisfaction degree scores ultimately improved in 86 patients as compared with preoperative degrees. Statistically significant increases occurred only in the composite scores of subscale mobility and self-rated satisfaction degrees in the first 3 months, while the composite scores of the remaining subscales, and the total CLVQOL, BCVA in the RRD eye and weighted average BCVA, increased steadily throughout the first postoperative year. A better 3-year postoperative weighted average BCVA was associated with all of the 3 dependent outcome variables. Conclusions VRQoL of RRD patients improved substantially after surgery and they were satisfied with their postoperative vision. The BCVA, VRQoL and self-rated satisfactory degree scores recovered in different patterns, and supplemented each other in the RRD surgery outcomes evaluated. Surgeons are advised to pay closer attention to binocular vision in RRD patients, and make efforts to explain the results of surgery.
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Zou H, Zhang X, Xu X, Liu H. Quality of Life in Subjects With Rhegmatogenous Retinal Detachment. Ophthalmic Epidemiol 2009; 15:212-7. [DOI: 10.1080/09286580701843804] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Miura M, Elsner AE, Cheney MC, Usui M, Iwasaki T. Imaging polarimetry and retinal blood vessel quantification at the epiretinal membrane. JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2007; 24:1431-7. [PMID: 17429490 PMCID: PMC2562903 DOI: 10.1364/josaa.24.001431] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We evaluated a polarimetry method to enhance retinal blood vessels masked by the epiretinal membrane. Depolarized light images were computed by removing the polarization retaining light reaching the instrument and were compared with parallel polarized light images, average reflectance images, and the corresponding images at 514 nm. Contrasts were computed for retinal vessel profiles for arteries and veins. Contrasts were higher in the 514 nm images in normal eyes but higher in the depolarized light image in the eyes with epiretinal membranes. Depolarized light images were useful for examining the retinal vasculature in the presence of retinal disease.
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Affiliation(s)
- Masahiro Miura
- Department of Ophthalmology, Tokyo Medical University, Japan.
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9
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Richter-Mueksch S, Kiss CG, Radner W, Binder S, Velikay-Parel M. Proliferative vitreoretinopathy--at what risk is the fellow eye? Wien Klin Wochenschr 2004; 116:32-6. [PMID: 15030121 DOI: 10.1007/bf03040421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To find out if patients with proliferative vitreoretinopathy (PVR) due to complicated retinal detachment are at risk to acquire the same disease or other vision-threatening retinal abnormalities in the fellow eye. To furthermore assess in what time-period they appear and if subgroups of patients have special risks. METHODS 100 consecutive PVR-patients were studied retrospectively. 21 patients with PVR graded lower than C3, traumatic PVR, diabetic retinopathy or congenital vitreoretinal diseases were excluded. Age, gender, best-corrected visual acuity at the first and last visit, refraction, ocular disease in both eyes and observation-time were recorded. RESULTS After a mean follow-up of 8.5 years, 42 of 79 patients (53.4%) showed vision-threatening abnormalities in their fellow eyes: among them, 9 patients (11.4%) had PVR, 13 (16%) simple retinal detachments and 14 (17.3%) retinal breaks. Abnormalities in the fellow eye did not develop after a certain time following surgery of the primary eye; 71.4% appeared within 5 years. Aphakic and pseudophakic patients had retinal breaks significantly more often (p = 0.011) than phakic patients. Myopia did not increase the risk for any abnormality. Men developed retinal detachment (p = 0.037) and PVR (p = 0.025) significantly more often than women. CONCLUSION Patients with PVR have a greater than 50% risk of developing vision-threatening retinal abnormalities in their fellow eye. Because of this increased risk, these patients need regularly-scheduled long-term follow-up. SUMMARY STATEMENT Patients with PVR have a greater than 50% risk of developing vision-threatening retinal abnormalities in their fellow eye and a 37% risk to develop PVR from rhegmatogenous retinal detachment. More than two thirds of abnormalities in the fellow eye developed within five years of surgery of the primary eye.
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10
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Scott IU, Loo RH, Flynn HW, Miller D. Endophthalmitis caused by enterococcus faecalis: antibiotic selection and treatment outcomes. Ophthalmology 2003; 110:1573-7. [PMID: 12917175 DOI: 10.1016/s0161-6420(03)00502-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate clinical settings, treatment strategies, and visual acuity outcomes of endophthalmitis caused by Enterococcus faecalis and to determine antibiotic sensitivity and resistance patterns. DESIGN Retrospective, noncomparative, consecutive case series. PARTICIPANTS AND METHODS Records were reviewed of all patients with culture-positive endophthalmitis caused by E. faecalis evaluated at the Bascom Palmer Eye Institute between January 1, 1990, and December 31, 2001. MAIN OUTCOME MEASURES Associated prior surgical procedures, clinical features, treatments administered, antibiotic sensitivity and resistance patterns, and final visual outcomes. RESULTS Endophthalmitis caused by E. faecalis was identified in 29 eyes of 29 patients. The mean follow-up was 17.8 months (range, 0.1-86.7 months). Endophthalmitis caused by E. faecalis was associated with, in order of decreasing frequency, cataract surgery in 12 of 29 eyes (41.4%), trabeculectomy in 8 of 29 eyes (27.6%), penetrating keratoplasty in 4 of 29 eyes (13.8%), combined cataract and trabeculectomy in 3 of 29 eyes (10.3%), seton implantation in 1 of 29 eyes (3.5%), and pupilloplasty in 1 of 29 eyes (3.5%). Resistance patterns among the isolates were the following: vancomycin in 0 of 23 eyes (0.0%), linezolid in 0 of 29 eyes (0.0%), ciprofloxacin in 1 of 14 eyes (7.1%), gentamicin (minimum inhibitory concentration >8 mg/l) in 8 of 16 eyes (50.0%), high-level gentamicin (minimum inhibitory concentration >500 mg/l) in 5 of 29 eyes (17.2%), cefazolin in 7 of 8 eyes (87.5%), and quinupristin and dalfopristin in 29 of 29 eyes (100.0%). Preinfection baseline visual acuities ranged from 20/30 to hand motions. Visual acuities on presentation with endophthalmitis ranged from 2/200 to no light perception. Final visual acuity was better than or equal to 20/50 in two cases (6.9%), 20/60 to 20/400 in three cases (10.3%), 5/200 to hand motions in 10 cases (34.5%), and light perception to no light perception in 14 cases (48.3%). CONCLUSIONS E. faecalis often is resistant to gentamicin and cephalosporins but was sensitive to vancomycin in all isolates tested. Endophthalmitis caused by E. faecalis usually is associated with poor visual outcomes.
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Affiliation(s)
- Ingrid U Scott
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33101, USA.
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Ranta P, Kivelä T. Functional and anatomic outcome of retinal detachment surgery in pseudophakic eyes. Ophthalmology 2002; 109:1432-40. [PMID: 12153792 DOI: 10.1016/s0161-6420(02)01111-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the long-term anatomic and functional visual outcome of retinal detachment (RD) surgery in pseudophakic eyes after uncomplicated cataract surgery. DESIGN An interventional, retrospective noncomparative case series PARTICIPANTS One hundred thirty-eight consecutive patients who had undergone uncomplicated extracapsular cataract extraction and intraocular lens implantation followed by rhegmatogenous RD between 1990 and 1995. METHODS One hundred one eligible patients were examined (inclusion ratio, 73%) a median of 4.3 years after last RD surgery. The best-corrected visual acuity (BCVA), visual fields, retinal status, and patient-rated visual outcome were recorded, the latter by a questionnaire that included self-reported satisfaction, trouble with vision, a modified Cataract Symptom Score, and the VF-14 Visual Functioning Index. MAIN OUTCOME MEASURES BCVA, retinal attachment, diameter of visual field, modified Cataract Symptom Score, VF-14 score. RESULTS Baseline characteristics of enrolled and nonenrolled patients were comparable, except that nonenrolled patients were older. When RD developed, 55 eyes had an intact posterior capsule, and 46 had a laser posterior capsulotomy (LCT). The BCVAs before (median, logarithm of the minimum angle of resolution [-logMAR] 1.2 versus 1.1, Snellen equivalent 0.063 versus 0.08) and after retinal surgery (median, -logMAR 0.46 versus 0.4, Snellen equivalent 0.35 versus 0.4) were comparable for eyes with and without LCT (P = 0.86). The retina was reattached with one procedure in 75 eyes (74%), with two procedures in 98 eyes (97%), and with three to five procedures in all eyes. The retina remained attached long term in 92 eyes (91%). Redetachment rate (9% versus 9%, P = 1.0) and visual field diameters were comparable for eyes with and without LCT. Overall, 80% of patients were satisfied or very satisfied with their binocular vision, and 62% had no or only a little trouble with binocular vision. Visual performance was similar regardless of presence or absence of LCT (median Cataract Symptom Score, 3.0 versus 3.0, P = 0.76; and median VF-14 score, 87.5 versus 87.5, P = 0.81). CONCLUSIONS Nine in 10 pseudophakic retinal detachments remain attached long term, and 8 in 10 patients are satisfied with their binocular vision after surgery. Even though secondary cataract and posterior capsulotomy can cause problems for the retinal surgeon, the anatomic and functional outcomes of pseudophakic RD are not influenced by capsulotomy.
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Affiliation(s)
- Päivi Ranta
- Department of Ophthalmology, Helsinki University Central Hospital, Finland
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Mackenzie PJ, Chang TS, Scott IU, Linder M, Hay D, Feuer WJ, Chambers K. Assessment of vision-related function in patients with age-related macular degeneration. Ophthalmology 2002; 109:720-9. [PMID: 11927429 DOI: 10.1016/s0161-6420(01)01021-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the validity of the visual function index (VF-14) in assessing visual function in patients with age-related macular degeneration (AMD). DESIGN Prospective noncomparative observational case series. PARTICIPANTS One hundred fifty-nine consecutive patients attending a sole practitioner's academic retina-only clinic from May 1998 through August 1998 and from May 1999 through August 1999. MAIN OUTCOME MEASURES Correlations were calculated between the VF-14 scores and the medical outcomes study 36-item short form (SF-36), weighted comorbidity scale, visual acuity and clinical AMD severity (stage), and vision self-assessment scales. Documentation of the severity of macular degeneration was performed by a sole examiner. RESULTS There was a moderately strong correlation between visual acuity and trouble with vision (r = 0.51), satisfaction with vision (r = -0.50), and overall quality of vision (r = -0.56). A strong correlation was noted between VF-14 score and patients' self-rating of amount of trouble with vision (r = -0.67), satisfaction with vision (r = 0.62), and overall quality of vision (r = 0.67). In comparison, correlations between SF-36 score and patients' self-rating of amount of trouble with vision, satisfaction with vision, and overall quality of vision ranged from r = 0.37 to r = -0.40. Linear regression analysis for the overall study population indicated that AMD severity was not an independently significant predictor of VF-14 score after adjusting for visual acuity. However, among patients with 20/20 vision in the better eye, AMD severity was an independently significant predictor of VF-14 score after adjusting for visual acuity in the worse eye. CONCLUSIONS The VF-14 exhibits a considerable degree of validity as a measure of functional impairment in patients with AMD. Age-related macular degeneration severity was an independently significant predictor of VF-14 score in the group of patients with 20/20 vision in the better eye, but this did not hold true for the overall study population. Age-related macular degeneration is associated with substantial impairment in reported visual function.
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Affiliation(s)
- Paul J Mackenzie
- Division of Vitreo-Retinal Surgery, Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
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13
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Scott IU, Feuer WJ, Jacko JA. Impact of visual function on computer task accuracy and reaction time in a cohort of patients with age-related macular degeneration. Am J Ophthalmol 2002; 133:350-7. [PMID: 11860972 DOI: 10.1016/s0002-9394(01)01406-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the impact of visual function parameters on computer task performance in patients with age-related macular degeneration (AMD). DESIGN Interventional case series. METHODS Eighteen patients with visual impairment due to age-related macular degeneration underwent evaluation of visual acuity using the Early Treatment Diabetic Retinopathy Study protocol, contrast sensitivity using a Pelli-Robson chart, binocular simultaneous visual field using the Esterman program on an automated perimeter, and color vision using Farnsworth D-15. Each subject then completed 125 computer icon identification tasks. Relationships between computer task performance (accuracy and speed) and visual function parameters (visual acuity, contrast sensitivity, visual field, and color vision) were analyzed. RESULTS Visual acuity and contrast sensitivity in the better eye, weighted average contrast sensitivity, and color vision defects are significantly associated with computer task accuracy. Visual acuity in the better eye, weighted average visual acuity, and color vision defects are significantly associated with performance speed. Visual function parameters and clinical features significantly associated with computer task accuracy in a multiple regression model include weighted average contrast sensitivity (P = 0.001), protan color vision defect (P = 0.002), cataract severity in the better-seeing eye (P = 0.036), and geographic atrophy outside the central macula (P = 0.046). Visual function parameters and clinical features significantly associated with computer task speed in a multiple regression model include color vision defects (deutan, P < 0.001; protan, P < 0.001) and gender (P = 0.05). CONCLUSIONS Among this cohort of patients with AMD, visual acuity, contrast sensitivity, and color vision defects are significant predictors of computer task performance. Visual function parameters of the better eye played a more significant role than parameters of the worse eye, and contrast sensitivity is the most significant predictor of computer task accuracy.
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Affiliation(s)
- Ingrid U Scott
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Miami, Florida 33101, USA.
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Loo RH, Scott IU, Flynn HW, Gass JDM, Murray TG, Lewis ML, Rosenfeld PJ, Smiddy WE. Factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy. Retina 2002; 22:19-24. [PMID: 11884873 DOI: 10.1097/00006982-200202000-00004] [Citation(s) in RCA: 293] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy (ICSC). METHODS Retrospective consecutive case series that included patients with ICSC who were younger than 50 years of age at the time of initial examination and were followed up for > or =3 years. RESULTS The mean follow-up for 101 involved eyes of 61 patients was 9.8 years (median, 8.0 years). Eyes were stratified into two groups based on visual acuity at the final examination: Group 1, visual acuity of 2040 or better; and Group 2, visual acuity of worse than 2040. Findings identified as potential risk factors for reduced vision at the final follow-up examinations for Group 1 versus Group 2 included the following: macular retinal pigment epithelium atrophy (90.8% versus 96.0%, respectively; P = 0.68); persistent pigment epithelial detachment or persistent subretinal fluid (5.3% versus 28.0%, respectively; P = 0.004); recurrences (39.5% versus 68.0%, respectively; P = 0.020); laser treatment (28.9% versus 32.0%, respectively; P = 0.80); and submacular choroidal neovascularization (0.0 versus 8.0%, respectively; P = 0.059). CONCLUSIONS Factors associated with reduced visual acuity during long-term follow-up of patients with ICSC included persistent pigment epithelial detachment and/or subretinal fluid, recurrences, and submacular choroidal neovascularization.
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Affiliation(s)
- Roy H Loo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33136, USA
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15
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Chaudhry NA, Flynn HW, Murray TG, Belfort A. Combined Cataract Surgery and Vitrectomy for Breakthrough Vitreous Hemorrhage from Age-Related Macular Degeneration. Ophthalmic Surg Lasers Imaging Retina 2002. [DOI: 10.3928/1542-8877-20020101-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Abstract
PURPOSE The measurement of outcomes of pediatric therapy will be increasingly important to third-party payers as they allocate health care resources. We undertook this study to assess the effectiveness of treatment of acquired esotropia, as measured subjectively by parents and objectively by examination. METHODS A chart review was used to gather objective clinical data from all patients presenting between 1994 and 1995 with esotropia after their first birthday. Parents' impressions of the quality and impact of treatment were tabulated by using a telephone questionnaire. RESULTS Of 48 patients studied (mean age, 3.8 years; 44 months' follow-up), the 26 with amblyopia were effectively treated in 81% of cases. Mean esotropic angles decreased, with glasses and/or surgery, from 33.1 to 4.9 PD at distance and from 40.0 to 11.4 PD at near. The average estimated cost of care was 547 dollars per patient per year. Parents considered treatment "extremely important" to their child's future happiness and success in 90% of cases. CONCLUSION Our experience has shown that treatment of acquired esotropia in childhood, while relatively inexpensive, is highly effective, both objectively and subjectively.
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Affiliation(s)
- P A Costello
- Department of Ophthalmology, Albany Medical College, New York, USA
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17
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Abstract
Pediatric ophthalmologists should respond to quality expectations inherent in all disciplines of medicine. The specialists must be able to collect data to document and prove the quality of their work if it anticipates continued reimbursement for services. Quality of medical practice is assessed by outcomes research, which is different from clinical research. All specialists are systemically measuring individual and group outcomes across the spectrum of American health care systems. Pediatric ophthalmologists, both in private practice and at academic centers, must concentrate their research efforts on the assessment of cost, quality, utilization, and patient-centered health-related quality of life for the most common pathologies in pediatric ophthalmology practice.
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Affiliation(s)
- R W Enzenauer
- Department of Ophthalmology, University of Tennessee College of Medicine, Chattanooga 37403, USA.
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18
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Livingstone BI, Bourke RD. Retrospective study of macular holes treated with pars plana vitrectomy. AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY 1999; 27:331-41. [PMID: 10571394 DOI: 10.1046/j.1440-1606.1999.00221.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Tangential vitreo-foveal traction resulting in full-thickness macular hole is an important cause of visual loss. PURPOSE To determine, correlate and evaluate the factors that affect the anatomical and visual outcome of macular hole surgery. METHOD Retrospective analysis of all cases of macular hole surgery undertaken by a single surgeon (RDB) between 1995 and 1998. RESULTS One hundred eyes were analysed with a minimum follow-up of 3 months. One operation anatomical success rate was 95%. Anatomically successful eyes had visual acuity improvement of one or more lines in 73.4% and two or more lines in 66.3%. Failure to remove diaphanous contractile 'epiretinal' membranes (presumably the internal limiting membrane) around the macular hole was significantly associated with anatomical failure (P < 0.001). Improvement of two or more lines of visual acuity was significantly associated with successful anatomical closure of the macular hole (P = 0.001). The success rate was highest in the more recent cases, suggesting a learning curve effect. Postoperatively, cataract developed or progressed in 96% of phakic eyes. Retinal detachment occurred in 6%, with all eyes having the retina reattached following subsequent surgery. Gross retinal pigment epithelial changes at the macula region developed in 3%. CONCLUSION Meticulous rapid dissection of adherent, diaphanous 'epiretinal' membrane around the macular hole, combined with gas tamponade and postoperative posturing, result in successful anatomical closure with improved visual acuity.
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19
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Abstract
According to the Early Treatment Diabetic Retinopathy Study, at least 5% of eyes receiving optimal medical treatment will still have progressive retinopathy that requires laser treatment and pars plana vitrectomy. During the past decade, improvements in instrumentation and surgical techniques have allowed more difficult cases of diabetic retinopathy to be candidates for vitrectomy. However, although the thresholds for performing surgery within established indicated situations have been lowered, only a few additional indications have been established. Although vitrectomy improves the prognosis for a favorable visual outcome, preventive measures, such as improved control of glucose levels and timely application of panretinal photocoagulation, produce better results. The authors review the indications, techniques, and results of vitrectomy in the management of diabetic retinopathy.
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Affiliation(s)
- W E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, FL, USA
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20
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Scott IU, Smiddy WE, Feuer W, Merikansky A. Vitreoretinal surgery outcomes: results of a patient satisfaction/functional status survey. Ophthalmology 1998; 105:795-803. [PMID: 9593378 DOI: 10.1016/s0161-6420(98)95017-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This study aimed to assess patient satisfaction and change in functional status after surgery for epiretinal membrane (ERM), rhegmatogenous retinal detachment (RRD), and complex retinal detachment (CRD). This study also aimed to determine whether objective measures of vision are predictive of subjective improvement after surgery. DESIGN The study design included patient interviews and retrospective chart review. PARTICIPANTS Participants were those patients who underwent surgery for ERM, RRD, or CRD by one surgeon at the Bascom Palmer Eye Institute between January 1, 1993, and December 31, 1994. INTERVENTION Patient satisfaction and patients' perceptions of the impact of surgery on their functional status were assessed by telephone interviews conducted by one interviewer at least 6 months after surgery. MAIN OUTCOME MEASURES Responses to patient satisfaction survey and subjective change in patients' functional status were measured. RESULTS Of 187 eligible patients, 146 (78.1%) could be contacted and all agreed to participate. Ninety patients (61.6%) reported improved functioning after surgery in 2 or more of the 5 activities investigated. Twenty-one patients (14.4%) reported worse postoperative vision than expected, but only 5 patients (3.4%) thought surgery had not been worthwhile. One hundred forty-three patients (97.9%) reported adequate explanation of surgery and its expected results. Patients with preoperative study eye visual acuity between 20/40 and 20/200 were most likely to improve in two or more activities. Lower preoperative worse eye vision and better final study eye vision were associated with a greater likelihood of satisfaction after surgery. Diagnostic category was not predictive of change in functional status or patient satisfaction. CONCLUSIONS There is a high rate of patient satisfaction and improved functional status after surgery for ERM, RRD, and CRD, even among patients with good fellow eye vision.
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Affiliation(s)
- I U Scott
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Florida 33139, USA
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