1
|
Muacevic A, Adler JR. Sudden Gross Visual Deterioration: Importance of Examining the Whole Eye. Cureus 2023; 15:e34374. [PMID: 36726769 PMCID: PMC9885514 DOI: 10.7759/cureus.34374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 02/03/2023] Open
Abstract
A 75-year-old caucasian female presented with sudden severe visual deterioration in one eye reduced from 6/9 to counting fingers (CF), with second eye reduction in vision from 6/9 to CF three months later. Past medical history included a background of proliferative diabetic retinopathy, uncontrolled blood pressure, and a 44-year history of poorly controlled type 1 diabetes mellitus (T1DM). Previous ocular history included bilateral pan-retinal photocoagulation for proliferative diabetic retinopathy, followed by bilateral vitrectomies, with subsequent bilateral cataract surgery with intraocular lens implants. A diagnosis of anterior ischemic optic neuropathy (AION) was thought to be the most likely diagnosis due to sudden visual loss, pale discs, and previous long-term history of diabetes and blood pressure with variable control in the absence of a raised erythrocyte sedimentation rate (ESR). However, at the time of the second eye visual loss, the inferior peripheral retina examination revealed bilateral pseudophakic intraocular lens dislocations. With spectacle correction of +11.50/-1.00 x 75 right eye and +11.50/-1.00 x 65 left eye, her visual acuities were 6/12 right eye and 6/9 left eye, and subsequent secondary intraocular lens insertion was planned. This case highlights the importance of a careful review of the whole eye to ensure that remediable causes of visual loss are not missed.
Collapse
|
2
|
Jha R, Priya B, Solu T, Patel I. Visual outcome and complications of small-incision cataract surgery. Oman J Ophthalmol 2023; 16:51-54. [PMID: 37007243 PMCID: PMC10062067 DOI: 10.4103/ojo.ojo_172_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/24/2022] [Accepted: 08/26/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Small-incision cataract surgery (SICS) is a commonly performed procedure in developing countries. It does not require expensive machines and can be safely done in high-volume centers also yielding good visual outcomes in the majority of patients. The objective of our study was to assess visual outcomes after SICS conducted at a tertiary care center in South Gujarat and also assessment of various complications responsible for poor visual outcomes. MATERIALS AND METHODS Three hundred and fifteen cataract patients were included in the study. An assessment of intraoperative and postoperative complications was done. Postoperative visual acuity assessment was done and compared with preoperative visual acuity of the patient and factors responsible for poor visual outcomes were assessed. A follow-up examination was done on days 1, 3, 7, 14, and 30. RESULTS The mean age group of patients was 59.3 years. Females were slightly more (53.3%) in number as compared to males. The most common surgical complication encountered were striate keratopathy (6.35%), followed by iris damage (5.71%), posterior capsular rent (PCR) with vitreous loss (3.14%), hypotony (0.63%), intraocular lens decentration (0.63%), surgery-induced astigmatism (0.63%), choroidal detachment (0.32%), endophthalmitis (0.32%), and hyphema (0.32%). About 95.87% of patients had vision better than 6/18. Complications associated with poor visual outcome (<6/18) were PCR, endophthalmitis, choroidal detachment, and surgical-induced astigmatism. CONCLUSIONS Although SICS can have a significant chance of complications, good visual outcomes can be attained in the majority of patients.
Collapse
|
3
|
Social, Educational and Medical Aspects after Cataract Surgery of Bilaterally Blind Children in Kinshasa—Perception of Parents and Children. CHILDREN 2022; 9:children9111683. [DOI: 10.3390/children9111683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
The study investigated the influence of bilateral cataract surgery on the social and educational development of previously bilaterally blind children in Sub-Saharan Africa (SSA), where the prevalence of blindness due to cataract is higher than in high-income countries. The views of both, parents and children, were evaluated with structured interviews based on a newly developed questionnaire related to surgery, follow-up, and family life after surgery. The mean age of the children at interview was 14.4 ± 8.1 years, with 27 females and 26 males. Satisfaction with the outcome of the surgery was reported by 91% of parents. Parents would recommend surgery, because of the children being happy and able to act more independently, with personal, educational and familial factors essentially contributing to the reported satisfaction. The results also showed that 85.0% of children did not wear eyeglasses. Reasons given were mainly cost-related, but also included limited communication between families and health institutions. Providing and maintaining a high-quality and accessible pediatric cataract surgery and healthcare service for follow-up is a major requisite to reduce childhood blindness in SSA. Our study proved the necessity and effectiveness of a community-based rehabilitation program that cares about each individual child, whatever his or her social background.
Collapse
|
4
|
Curran K, Congdon N, Hoang TT, Lohfeld L, Nguyen VT, Nguyen HT, Nguyen QN, Dardis C, Virgili G, Piyasena P, Tran H, Salongcay RP, Tung MQ, Peto T. Impact of targeted diabetic retinopathy training for graders in Vietnam and the implications for future diabetic retinopathy screening programmes: a diagnostic test accuracy study. BMJ Open 2022; 12:e059205. [PMID: 36691192 PMCID: PMC9472142 DOI: 10.1136/bmjopen-2021-059205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 08/03/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To compare the accuracy of trained level 1 diabetic retinopathy (DR) graders (nurses, endocrinologists and one general practitioner), level 2 graders (midlevel ophthalmologists) and level 3 graders (senior ophthalmologists) in Vietnam against a reference standard from the UK and assess the impact of supplementary targeted grader training. DESIGN Diagnostic test accuracy study. SETTING Secondary care hospitals in Southern Vietnam. PARTICIPANTS DR training was delivered to Vietnamese graders in February 2018 by National Health Service (NHS) UK graders. Two-field retinal images (412 patient images) were graded by 14 trained graders in Vietnam between August and October 2018 and then regraded retrospectively by an NHS-certified reference standard UK optometrist (phase I). Further DR training based on phase I results was delivered to graders in November 2019. After training, a randomised subset of images from January to October 2020 (115 patient images) was graded by six of the original cohort (phase II). The reference grader regraded all images from phase I and II retrospectively in masked fashion. PRIMARY AND SECONDARY OUTCOME MEASURES Sensitivity was calculated at the two different time points, and χ2 was used to test significance. RESULTS In phase I, the sensitivity for detecting any DR for all grader groups in Vietnam was low (41.8-42.2%) and improved in phase II after additional training was delivered (51.3-87.2%). The greatest improvement was seen among level 1 graders (p<0.001), and the lowest improvement was observed among level 3 graders (p=0.326). There was a statistically significant improvement in sensitivity for detecting referable DR and referable diabetic macular oedema between all grader levels. The post-training values ranged from 40.0 to 61.5% (including ungradable images) and 55.6%-90.0% (excluding ungradable images). CONCLUSIONS This study demonstrates that targeted training interventions can improve accuracy of DR grading. These findings have important implications for improving service delivery in DR screening programmes in low-resource settings.
Collapse
Affiliation(s)
- Katie Curran
- Centre of Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
| | - Nathan Congdon
- Centre of Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- ORBIS International, New York, New York, USA
| | - Tung Thanh Hoang
- Department of Ophthalmology, Hanoi Medical University, Hanoi, Viet Nam
- Save Sight Institute, The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Lynne Lohfeld
- Centre of Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | | | | | - Quan Nhu Nguyen
- Vitreo-Retina Department, Ho Chi Minh Eye Hospital, Ho Chi Minh City, Viet Nam
| | - Catherine Dardis
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK
| | - Gianni Virgili
- Centre of Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK
| | - Prabhath Piyasena
- Centre of Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
| | - Huong Tran
- Orbis International in Vietnam, Hanoi, Viet Nam
| | - Recivall Pascual Salongcay
- Centre of Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
| | - Mai Quoc Tung
- Vitreo-Retina Department, Ho Chi Minh Eye Hospital, Ho Chi Minh City, Viet Nam
| | - Tunde Peto
- Centre of Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK
| |
Collapse
|
5
|
Moussa O, Frank T, Valenzuela IA, Aliancy J, Gong D, De Rojas JO, Dagi Glass LR, Winn BJ, Cioffi GA, Chen RWS. Efficacy of Preoperative Risk Stratification on Resident Phacoemulsification Surgeries. Clin Ophthalmol 2022; 16:2137-2144. [PMID: 35800673 PMCID: PMC9255418 DOI: 10.2147/opth.s368633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate efficacy of a novel risk stratification system in minimizing resident surgical complications and to evaluate whether the system could be used to safely introduce cataract surgery to earlier levels of training. Materials and Methods This is a retrospective cross-sectional study on 530 non-consecutive cataract cases performed by residents at Columbia University. Risk scores, preoperative best corrected visual acuity (BCVA), intraoperative complications, postoperative day 1 (POD1), and month 1 (POM1) exam findings were tabulated. The relationship between risk scores and POD1 and POM1 BCVA was modeled using linear regression. The relationship between risk scores and complication rates was modeled using logistic regression. Logistic regression was used to model the rates of complications across different levels of training. Rates of complications were compared between diabetic versus non-diabetic patients using t-tests. Results Risk scores did not have significant association with intraoperative complications. Risk scores were predictive of corneal edema (OR = 1.36, p = 0.0032) and having any POM1 complication (OR = 1.20, p = 0.034). Risk scores were predictive of POD1 (β = 0.13, p < 0.0001) and POM1 (β = 0.057, p = 0.00048) visual acuity. There was no significant association between level of training and rates of intraoperative (p = 0.9) or postoperative complications (p = 0.06). Rates of intraoperative complication trended higher among diabetic patients but was not statistically significant (p = 0.2). Conclusion Higher risk scores were predictive of prolonged corneal edema but not risk of intraoperative complications. Our risk stratification system allowed us to safely introduce earlier phacoemulsification surgery.
Collapse
Affiliation(s)
- Omar Moussa
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Tahvi Frank
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ives A Valenzuela
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Joah Aliancy
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Dan Gong
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | | | - Lora R Dagi Glass
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - George A Cioffi
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Royce W S Chen
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
- Correspondence: Royce WS Chen, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 W. 165th St, New York, NY, 10032, USA, Tel +1 212-305-9535, Email
| |
Collapse
|
6
|
Hicks PM, Siedlecki A, Haaland B, Owen LA, Au E, Feehan M, Murtaugh MA, Sieminski S, Reynolds A, Lillvis J, DeAngelis MM. A global genetic epidemiological review of pseudoexfoliation syndrome. EXPLORATION OF MEDICINE 2021. [DOI: 10.37349/emed.2021.00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pseudoexfoliation (PXF) syndrome is an important public health concern requiring individual population level analysis. Disease prevalence differs by geographic location and ethnicity, and has environmental, demographic, genetic, and molecular risk factors have been demonstrated. Epidemiological factors that have been associated with PXF include age, sex, environmental factors, and diet. Genetic and molecular components have also been identified that are associated with PXF. Underserved populations are often understudied within scientific research, including research about eye disease such as PXF, contributing to the persistence of health disparities within these populations. In each population, PXF needs may be different, and by having research that identifies individual population needs about PXF, the resources in that population can be more efficiently utilized. Otherwise, PXF intervention and care management based only on the broadest level of understanding may continue to exacerbate health disparities in populations disproportionally burdened by PXF.
Collapse
Affiliation(s)
- Patrice M. Hicks
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USA;Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Adam Siedlecki
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA
| | - Benjamin Haaland
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USA
| | - Leah A. Owen
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USA;Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA;Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA
| | - Elizabeth Au
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA
| | - Michael Feehan
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USA;Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA;Cerner Enviza, Kansas City, MO 64117, USA
| | - Maureen A. Murtaugh
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USA;Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Sandra Sieminski
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA
| | - Andrew Reynolds
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA
| | - John Lillvis
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA;VA Western New York Healthcare System, Buffalo, NY 14215, USA
| | - Margaret M. DeAngelis
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USA;Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA;Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA;VA Western New York Healthcare System, Buffalo, NY 14215, USA
| |
Collapse
|
7
|
Abstract
To investigate the national burden of eye diseases in China from 1990 to 2019. The national burden of eye diseases in China, including case numbers, prevalence rate, age-standardized prevalence rate (ASR), disability-adjusted life year (DALY), DALY rate and age-standardized DALY rate (ASD) were calculated and stratified by sex and age. The trends of eye diseases burden from 1990 to 2019 and the correlation between eye diseases burden and human development index (HDI) were analyzed. In 2019, the total case number of eye diseases in China was 0.21 billion, the ASR was 9511/10, the total number of DALY was 4.72 million, and the ASD was 247.4/10. Near vision loss caused the greatest burden, followed by refraction disorders and cataract, with ASD being 73.8/10, 70.3/10 and 59.2/10, respectively. Men had lower risks of eye diseases than women. People aged old and old had the greatest burden of eye diseases. Compared with the year 1990, the total case number increased by 134.6% and DALY by 113.0% in 2019. The ASD of all decreased by 7.5%, and was negatively correlated with national HDI. Near vision loss, refraction disorders and cataract are of heavy disease burden in China. Although the ASD of eye diseases is decreased with the development of the national socioeconomic status, the eye diseases burden in China still increased with population growth and aging.
Collapse
Affiliation(s)
- Binbin Chen
- Ophthalmology Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Lixia Lou
- Ophthalmology Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Juan Ye
- Ophthalmology Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| |
Collapse
|
8
|
Kristianslund O, Dalby M, Drolsum L. Late in-the-bag intraocular lens dislocation. J Cataract Refract Surg 2021; 47:942-954. [PMID: 33750091 DOI: 10.1097/j.jcrs.0000000000000605] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/05/2021] [Indexed: 12/21/2022]
Abstract
This review aimed to evaluate the cumulative incidence, patient characteristics, predisposing conditions, and treatment outcomes for late in-the-bag intraocular lens (IOL) dislocation. Literature searches in PubMed (MEDLINE), Embase, and Cochrane Library Central database identified 1 randomized clinical trial, 1 prospective case series, 2 prospective cohort studies, and 36 retrospective studies of this condition, which showed that the cumulative incidence was 0.5% to 3%, it occurred on average 6 to 12 years after cataract surgery, and mean patient age was 65 to 85 years. Pseudoexfoliation syndrome, myopia, and previous vitreoretinal surgery were the most common predisposing conditions. Studies indicated that IOL repositioning and IOL exchange provided similar visual outcomes and were equally safe. The long-term visual outcome seemed satisfactory. However, the quality of evidence regarding treatment was in general quite low. More studies of late in-the-bag IOL dislocation are needed, and in particular, different surgical techniques should be included in high-quality clinical trials.
Collapse
Affiliation(s)
- Olav Kristianslund
- From the Department of Ophthalmology, Oslo University Hospital, Oslo Norway (Kristianslund, Dalby, Drolsum); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Kristianslund, Dalby, Drolsum)
| | | | | |
Collapse
|
9
|
Kudva AA, Lasrado AS, Hegde S, Kadri R, Devika P, Shetty A. Corneal endothelial cell changes in diabetics versus age group matched nondiabetics after manual small incision cataract surgery. Indian J Ophthalmol 2020; 68:72-76. [PMID: 31856472 PMCID: PMC6951183 DOI: 10.4103/ijo.ijo_406_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: To assess and compare the endothelial cell changes after manual small incision cataract surgery (SICS) in diabetic patients versus age group matched non-diabetic patients. Methods: This comparative prospective observational follow-up study included 54 diabetic patients and 52 control patients without diabetes who underwent manual SICS. Preoperative, one day, one week, one month and three months post-surgery assessments of corneal endothelial cell changes were done using specular microscopy. Data analysis was performed using SPSS software (version 20.0, SPSS, Inc.). Mann–Whitney U test was used to compare the data between the test group and control group. Results: There was drop in the endothelial density in both the groups postoperatively, with the mean percentage of endothelial loss at three months post- surgery being 27.5% in diabetics and 18.3% in controls. There was also a significant increase in central corneal thickness and coefficient of variance in diabetics as compared to controls at every follow up one day, one week, one month and three months. The percentage of hexagonality was statistically significant at post-operative three months. Conclusion: The diabetic endothelium was found to be under greater metabolic stress and had less functional reserve after manual SICS than the normal corneal endothelium.
Collapse
Affiliation(s)
- Ajay A Kudva
- Department of Ophthalmology, A. J. Institute of Medical Sciences and Research Center, Kuntikana, Mangalore, Karnataka, India
| | - Adeline S Lasrado
- Department of Ophthalmology, A. J. Institute of Medical Sciences and Research Center, Kuntikana, Mangalore, Karnataka, India
| | - Sudhir Hegde
- Department of Ophthalmology, A. J. Institute of Medical Sciences and Research Center, Kuntikana, Mangalore, Karnataka, India
| | - Rajani Kadri
- Department of Ophthalmology, A. J. Institute of Medical Sciences and Research Center, Kuntikana, Mangalore, Karnataka, India
| | - P Devika
- Department of Ophthalmology, A. J. Institute of Medical Sciences and Research Center, Kuntikana, Mangalore, Karnataka, India
| | - Akansha Shetty
- Department of Ophthalmology, A. J. Institute of Medical Sciences and Research Center, Kuntikana, Mangalore, Karnataka, India
| |
Collapse
|
10
|
Seo Y, Kim S, Lee HS, Park J, Lee K, Jun I, Seo H, Kim YJ, Yoo Y, Choi BC, Seok HK, Kim YC, Ok MR, Choi J, Joo CK, Jeon H. Femtosecond laser induced nano-textured micropatterning to regulate cell functions on implanted biomaterials. Acta Biomater 2020; 116:138-148. [PMID: 32890750 DOI: 10.1016/j.actbio.2020.08.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/15/2022]
Abstract
Posterior capsular opacification (PCO) is the most common complication of cataract surgery. PCO is due to the proliferation, migration, and epithelial-to-mesenchymal transition of the residual lens epithelial cells (LECs) within the lens capsule. As surface topography influences cellular response, we investigated the effect of modulating the dimensions of periodic nano-textured patterns on the surface of an intraocular lens material to regulate lens epithelial cell functions such as cell adhesion, migration, orientation, and proliferation. Patterned poly(HEMA) samples were prepared by a femtosecond laser microfabrication, and the behaviors of human B-3 LECs were observed on groove/ridge patterns with widths varying from 5 to 40 µm. In the presence of ridge and groove patterns, the adherent cells elongated along the direction of the patterns, and f-actin of the cells was spread to a lesser extent on the nano-textured groove surfaces. Both single and collective cell migrations were significantly inhibited in the perpendicular direction of the patterns on the nano-textured micro-patterned samples. We also fabricated the patterns on the curved surface of a commercially available intraocular lens for in vivo evaluation. In vivo results showed that a patterned IOL could help suppress the progression of PCO by inhibiting cell migration from the edge to the center of the IOL. Our reports demonstrate that nano- and microscale topographical patterns on a biomaterial surface can regulate cellular behavior when it is implanted into animals.
Collapse
Affiliation(s)
- Youngmin Seo
- Center for Biomaterials, Korea Institute of Science & Technology, Seoul 02792, Republic of Korea
| | - Saeromi Kim
- Center for Biomaterials, Korea Institute of Science & Technology, Seoul 02792, Republic of Korea
| | - Hyun Soo Lee
- Catholic Institute of Visual Science, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; Department of Ophthalmology, Catholic Institute for Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jaeho Park
- Center for Biomaterials, Korea Institute of Science & Technology, Seoul 02792, Republic of Korea
| | - Kyungwoo Lee
- Center for Biomaterials, Korea Institute of Science & Technology, Seoul 02792, Republic of Korea; School of Integrative Engineering, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Indong Jun
- Environmental Safety Group, Korea Institute of Science and Technology Europe Forschungsgesellschaft mbH, Saarbrucken 66123, Germany
| | - Hyunseon Seo
- Center for Biomaterials, Korea Institute of Science & Technology, Seoul 02792, Republic of Korea
| | - Young Jin Kim
- Public Problem Research Team, National Institute of Mathematical and Sciences, Daejeon 34037, Republic of Korea
| | - Youngsik Yoo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | | | - Hyun-Kwang Seok
- Center for Biomaterials, Korea Institute of Science & Technology, Seoul 02792, Republic of Korea; Division of Bio-Medical Science and Technology, Korea Institute of Science and Technology School, Korea University of Science and Technology, Seoul 02792, Republic of Korea
| | - Yu-Chan Kim
- Center for Biomaterials, Korea Institute of Science & Technology, Seoul 02792, Republic of Korea; Division of Bio-Medical Science and Technology, Korea Institute of Science and Technology School, Korea University of Science and Technology, Seoul 02792, Republic of Korea
| | - Myoung-Ryul Ok
- Center for Biomaterials, Korea Institute of Science & Technology, Seoul 02792, Republic of Korea
| | - Jonghoon Choi
- School of Integrative Engineering, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Choun-Ki Joo
- CK Saint Mary's Eye Center, Seoul 06531, Republic of Korea.
| | - Hojeong Jeon
- Center for Biomaterials, Korea Institute of Science & Technology, Seoul 02792, Republic of Korea; Division of Bio-Medical Science and Technology, Korea Institute of Science and Technology School, Korea University of Science and Technology, Seoul 02792, Republic of Korea.
| |
Collapse
|
11
|
Haider Shaheen K, Ullah MS, Hussain SA, Furqan A. Intracameral Triamcinolone Acetonide Versus Topical Dexamethasone: A Comparison of Anti-inflammatory Effects After Phacoemulsification. Cureus 2020; 12:e7592. [PMID: 32399326 PMCID: PMC7212759 DOI: 10.7759/cureus.7592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Study objective and design The objective of this study was to determine the effectiveness of triamcinolone acetonide when used as a single dose as compared to the topical use of dexamethasone to control the inflammation after phacoemulsification. The study was a randomized controlled trial conducted in the Department of Ophthalmology at the District Headquarter (DHQ) Teaching Hospital, Dera Ghazi Khan, from March 1, 2018, to August 31, 2019. Materials and methods Eighty patients were included in the study. All patients were assigned to two groups of 40 patients each using the lottery method. Group A patients were treated with a 1-mg intracameral injection of triamcinolone acetonide postoperatively after phacoemulsification. Group B patients were administered 0.1% dexamethasone eye drops with a dosage of one drop every four hours for four weeks. Postoperative follow-up was planned for day one, day seven, and day 28. Results The postoperative inflammation cell values of Group A on day one, day seven, and day 28 were 1.68 ±0.84, 0.22 ±0.15, and 0.12 ±0.23, respectively, while the postoperative inflammation cell values of Group B on day one, day seven, and day 28 were 1.91 ±0.75, 0.28 ±0.15, and 0.09 ±0.20, respectively. The postoperative inflammation flare values of Group A on day one, day seven, and day 28 were 0.31 ±0.37, 0.03 ±0.44, and 0.00 ±0.22, respectively, while the postoperative inflammation flare values of Group B on day one, day seven, and day 28 were 0.25 ±0.26, 0.22 ±0.46, and 0.02 ±0.18, respectively. Conclusion The efficacy of both modes of treatments is comparable; however, triamcinolone acetonide is preferable to dexamethasone, as its intracameral injection generally results in better compliance than multiple dosages of topical eye drops of dexamethasone.
Collapse
Affiliation(s)
| | | | - Syed Ahmer Hussain
- Ophthalmology, District Headquarter Teaching Hospital, Dera Ghazi Khan, PAK
| | - Aamir Furqan
- Anesthesia and Critical Care, Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, PAK
| |
Collapse
|
12
|
Raznahan M, Emamian MH, Alipour F, Hashemi H, Zeraati H, Fotouhi A. Horizontal inequity in the utilization of cataract surgery in Iran: Shahroud Eye Cohort Study, 2009-2014. Med J Islam Repub Iran 2019; 33:116. [PMID: 31934575 PMCID: PMC6946921 DOI: 10.34171/mjiri.33.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Since there was no evidence about economic inequity in utilization of cataract surgery in developing countries, such as Iran, this study was designed to measure horizontal inequity in the utilization of cataract surgery and its changes in an Iranian middleaged population in 2009 and 2014. Methods: Using data from the first and second phases of Shahroud Eye Cohort Study (2009-2014), the economic inequity in the utilization of cataract surgery in an Iranian middle-aged population aged 40-64 years in 2009 and 2014 was evaluated. The horizontal inequity index (HI) was determined using the indirect standardization method based on a nonlinear (probit) model and the concentration index (C) was decomposed into the contribution of each factor. The analyses were performed using STATA software version 12/SE, and significance level was set at less than 0.05. Results: The HI in the utilization of cataract surgery increased from 0.080 (95% CI: 0.011-0.098) in 2009 to 0.166 (95% CI: 0.0821- 0.228) in 2014. Decomposition of changes in the concentration index showed that among need and non-need variables, older age and economic status (being among the wealthiest 20%) were the greatest contributors, with shares of 67.5% and 57.5%%, respectively, which led to pro-rich inequity during the study periods. Conclusion: The present study demonstrated that utilization of cataract surgery did not have an equal distribution among economic quintiles, despite considering equal needs based on cataract severity. Results demonstrated that older age and economic status were the greatest contributors to HI increase in 2009 and 2014.
Collapse
Affiliation(s)
- Maedeh Raznahan
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
- Deputy of Research, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Emamian
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Fateme Alipour
- Eye Research Center, Farabi Eye Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Hojjat Zeraati
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
13
|
Zvorničanin J. Corneal astigmatism in cataract surgery patients from Bosnia and Herzegovina. Int Ophthalmol 2018; 39:1753-1760. [PMID: 30051216 DOI: 10.1007/s10792-018-0998-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/21/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE To determine corneal astigmatism prevalence, its correlations with age and symmetry pattern in fellow eyes of patients undergoing cataract surgery. METHODS This is a clinical-based retrospective cross-sectional study. Keratometry measurements of patients undergoing cataract surgery assigned to University Clinical Center Tuzla, Bosnia and Herzegovina, between January 2011 and June 2012 were recorded and analyzed retrospectively. RESULTS The study consisted of 4080 eyes of 2205 consecutive cataract surgery patients with a mean age of 68.24 years ± 9.25 (SD) (range 32-84 years), and 54.0% of the patients were women. Mean corneal astigmatism was 0.72 ± 0.61 D (range 0-6.5 D). The prevalence of corneal astigmatism 1.0 D or more was in 1291 eyes (31.64%), 1.5 D or more in 736 eyes (18.03%), 2.0 D or more in 396 eyes (9.71%) and 3.0 D or more in 108 eyes (2.65%). There was no significant difference in the magnitude of astigmatism between age groups (p = 0.10), male and female (p = 0.29) or right and left (p = 0.75) eyes. The prevalence and amount of astigmatism increased with age (p < 0.05). Gradual shift from with-the-rule astigmatism toward against-the-rule astigmatism was observed (p = 0.03). Patients with higher amount of astigmatism in one eye are more likely to have significant astigmatism in fellow eye (p < 0.01). Symmetry in pairs of eyes is present in eyes with astigmatism greater than 2.5 D (p < 0.01). CONCLUSION This study provides useful reference data for cataract surgeons and patients from Bosnia and Herzegovina.
Collapse
Affiliation(s)
- Jasmin Zvorničanin
- Department of Ophthalmology, University Clinical Center Tuzla, Trnovac bb, 75000, Tuzla, Bosnia and Herzegovina.
| |
Collapse
|
14
|
Amritanand A, Jasper S, Paul P, Kuriakose T. Facilitating factors in overcoming barriers to cataract surgical services among the bilaterally cataract blind in Southern India: A cross-sectional study. Indian J Ophthalmol 2018; 66:963-968. [PMID: 29941740 PMCID: PMC6032741 DOI: 10.4103/ijo.ijo_216_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To effectively address cataract blindness, increasing sight-restoring surgeries among the bilaterally blind are essential. To improve uptake of surgical services among this group, evidence regarding the problems of access is vital. Barriers in accessing eye care services have previously been reported but not specific to bilaterally cataract blind patients. Further, there is a gap in knowledge regarding factors facilitating access to eye care. Our aims were to (1) report proportion of bilaterally cataract blind patients undergoing surgery and sight restoration rate (SRR) and (2) analyze barriers and factors enabling access to eye care services among bilaterally cataract blind patients. Methods Retrospective analysis of interview and clinical data of bilaterally cataract blind patients undergoing surgery through outreach services at the base hospital, from June 2015 to May 2016, was performed. Demographic data, vision, postoperative visual outcomes, barriers, and facilitating factors in accessing cataract surgical services were obtained. Results Bilateral cataract blindness was present in 196/3178 (6.2%, 95% confidence interval 5.4-7.06) patients. SRR was 6.5%. Fear of surgery (24.2%) and lack of family support/escort (22.9%) were the most common barriers. Neighbors and acquaintances (28.6%), general health workers (20.2%), and persons who had undergone cataract surgery (19.6%) were the most common facilitating factors. Conclusion Proportion of bilaterally cataract blind people undergoing surgery and consequently SRR were low. The most common barriers were at the individual level while facilitating factors at the community level were instrumental in promoting uptake of services. Interventions involving community-based support for the blind may be useful in overcoming barriers to eye care.
Collapse
Affiliation(s)
- Anika Amritanand
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Smitha Jasper
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Padma Paul
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas Kuriakose
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
15
|
Abstract
Globally, 32.4 million individuals are blind and 191 million have moderate or severe visual impairment (MSVI); 80% of cases of blindness and MSVI are avoidable. However, great efforts are needed to tackle blindness and MSVI, as eye care in most places is delivered in isolation from and without significant integration with general health sectors. Success stories, including control of vitamin A deficiency, onchocerciasis, and trachoma, showed that global partnerships, multisectoral collaboration, public-private partnerships, corporate philanthropy, support from nongovernmental organizations-both local and international-and governments are responsible for the success of these programs. Hence, the World Health Organization's universal eye health global action plan for 2014-2019 has a goal of reducing the public health problem of blindness and ensuring access to comprehensive eye care; the plan aims to integrate eye health into health systems, thus providing universal eye health coverage (UEHC). This article discusses the challenges faced by low- and middle-income countries in strengthening the six building blocks of the health system. It discusses how the health systems in these countries need to be geared toward tackling the issues of emerging noncommunicable eye diseases, existing infectious diseases, and the common causes of blindness and visual impairment, such as cataract and refractive error. It also discusses how some of the comprehensive eye care models in the developing world have addressed these challenges. Moving ahead, if we are to achieve UEHC, we need to develop robust, sustainable, good-quality, comprehensive eye care programs throughout the world, focusing on the areas of greatest need. We also need to develop public health approaches for more complex problems such as diabetic retinopathy, glaucoma, childhood blindness, corneal blindness, and low vision. There is also a great need to train high-level human resources of all cadres in adequate numbers and quality. In addition to this, we need to exploit the benefits of modern technological innovations in information, communications, biomedical technology, and other domains to enhance quality of, access to, and equity in eye care.
Collapse
Affiliation(s)
- Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad 500034, India.,Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Gullapalli N Rao
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad 500034, India
| |
Collapse
|
16
|
Ramke J, Zwi AB, Lee AC, Blignault I, Gilbert CE. Inequality in cataract blindness and services: moving beyond unidimensional analyses of social position. Br J Ophthalmol 2017; 101:395-400. [PMID: 28228412 DOI: 10.1136/bjophthalmol-2016-309691] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/20/2016] [Accepted: 01/14/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Inequalities in cataract blindness are well known, but data are rarely disaggregated to explore the combined effects of a range of axes describing social disadvantage. We examined inequalities in cataract blindness and services at the intersection of three social axes. METHODS Three dichotomous social variables (sex (male/female); place of residence (urban/rural); literacy (literate/illiterate)) from cross-sectional national blindness surveys in Pakistan (2001-2004; n=16 507) and Nigeria (2005-2007; n=13 591) were used to construct eight subgroups, with disadvantaged subgroups selected a priori (ie, women, rural dwellers, illiterate). In each data set, the social distribution of cataract blindness, cataract surgical coverage (CSC) and effective cataract surgical coverage (eCSC) were examined. Inequalities were assessed comparing the best-off and worst-off subgroups using rate differences and rate ratios (RRs). Logistic regression was used to assess cumulative effects of multiple disadvantage. RESULTS Disadvantaged subgroups experienced higher prevalence of cataract blindness, lower CSC and lower eCSC in both countries. A social gradient was present for CSC and eCSC, with coverage increasing as social position improved. Relative inequality in eCSC was approximately twice as high as CSC (Pakistan: eCSC RR 2.7 vs CSC RR 1.3; Nigeria: eCSC RR 8.7 vs CSC RR 4.1). Cumulative disadvantage was observed for all outcomes, deteriorating further with each additional axis along which disadvantage was experienced. CONCLUSIONS Each outcome tended to be worse with the addition of each layer of social disadvantage. Illiterate, rural women fared worst in both settings. Moving beyond unidimensional analyses of social position identified subgroups in most need; this permits a more nuanced response to addressing the inequitable distribution of cataract blindness.
Collapse
Affiliation(s)
- Jacqueline Ramke
- University of New South Wales, School of Social Sciences, Faculty of Arts and Social Sciences, Sydney, New South Wales, Australia.,University of Auckland, School of Population Health, Auckland, New Zealand
| | - Anthony B Zwi
- University of New South Wales, School of Social Sciences, Faculty of Arts and Social Sciences, Sydney, New South Wales, Australia.,Health, Rights and Development, UNSW (@HEARDatUNSW), Sydney, Australia
| | - Arier C Lee
- University of Auckland, School of Population Health, Auckland, New Zealand
| | - Ilse Blignault
- University of New South Wales, School of Public Health and Community Medicine, Sydney, New South Wales, Australia.,Western Sydney University, School of Medicine, Centre for Health Research, Campbelltown, New South Wales, Australia
| | - Clare E Gilbert
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
17
|
|
18
|
Muhit M, Wadud Z, Islam J, Khair Z, Shamanna BR, Jung J, Khandaker G. Generating Evidence for Program Planning: Rapid Assessment of Avoidable Blindness in Bangladesh. Ophthalmic Epidemiol 2016; 23:176-84. [DOI: 10.3109/09286586.2016.1155716] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Mohammad Muhit
- Child Sight Foundation (CSF), Dhaka, Bangladesh
- Faculty of Public Health and Life Sciences, University of South Asia, Dhaka, Bangladesh
| | - Zakia Wadud
- Child Sight Foundation (CSF), Dhaka, Bangladesh
| | | | | | - BR Shamanna
- School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Jenny Jung
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Gulam Khandaker
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia
| |
Collapse
|
19
|
Ramke J, Zwi AB, Palagyi A, Blignault I, Gilbert CE. Equity and Blindness: Closing Evidence Gaps to Support Universal Eye Health. Ophthalmic Epidemiol 2015; 22:297-307. [DOI: 10.3109/09286586.2015.1077977] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
20
|
[Clinical practice variation in cataract surgery]. ACTA ACUST UNITED AC 2014; 90:220-32. [PMID: 25475557 DOI: 10.1016/j.oftal.2014.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Cataract surgery rates have dramatically increased in the last two decades. However, clinical practice variation in cataract surgery has not been thoroughly studied. The aim of this review is to analyze clinical practice variation, including the causes and consequences of this phenomenon. Then, its role in health care planning and health care quality is focused, emphasizing the importance of reducing it and providing several practical strategies to accomplish it. RECENT FINDINGS The latest researches are presented in this article. They identify the development and implementation of clinical practice guidelines as the best tool to standardize care processes. CONCLUSION Managing unwarranted or unwanted variation would improve quality of care and may lead to a significant saving in health care spending.
Collapse
|
21
|
Marmamula S, Narsaiah S, Shekhar K, Khanna RC, Rao GN. Visual impairment in the South Indian state of Andhra Pradesh: Andhra Pradesh - rapid assessment of visual impairment (AP-RAVI) project. PLoS One 2013; 8:e70120. [PMID: 23894601 PMCID: PMC3720942 DOI: 10.1371/journal.pone.0070120] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 06/17/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess the prevalence and causes of visual impairment in urban and rural population aged ≥ 40 years in the South India state of Andhra Pradesh. METHODS A population based cross-sectional study was conducted in which 7800 subjects were sampled from two rural and an urban locations. Visual Acuity (VA) was assessed using a tumbling E chart and eye examinations were performed by trained vision technicians. A questionnaire was used to collect personal and demographic information and previous consultation to eye care providers. Blindness and moderate Visual Impairment (VI) was defined as presenting VA <6/60 and <6/18 to 6/60 in the better eye respectively. VI included blindness and moderate VI. RESULTS Of the 7800 subjects enumerated, 7378 (94.6%) were examined. Among those examined, 46.4% were male and 61.8% of them had no education. The mean age of those examined (51.7 years; standard deviation 10.9 years) was similar to those not examined (52.8 years; standard deviation 9.9 years) (p=0.048). Age and gender adjusted prevalence of VI was 14.3% (95% CI: 13.5-15.0). Refractive errors were the leading cause of VI accounting for 47.6% of all VI followed by cataract (43.7%). Together, they contributed to over 91.3% of the total VI. With multiple logistic regression, the odds of having VI increased significantly with increasing age. Those respondents who had no education were twice (95% CI: 1.7-2.5) more likely to have VI compared to those who were educated. VI was associated with rural residence (OR: 1.3; 95% CI: 1.1-1.6). The association between VI and gender was not statistically significant. CONCLUSIONS The visual impairment remains a public health challenge in Andhra Pradesh, most of which can be addressed with relatively straight forward interventions like cataract surgery and spectacles. The eye care services need to be streamlined to address this challenge.
Collapse
Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India.
| | | | | | | | | |
Collapse
|
22
|
Bastawrous A, Dean WH, Sherwin JC. Blindness and visual impairment due to age-related cataract in sub-Saharan Africa: a systematic review of recent population-based studies. Br J Ophthalmol 2013; 97:1237-43. [PMID: 23696652 DOI: 10.1136/bjophthalmol-2013-303135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM We aimed to evaluate age-related cataract as a contributor to blindness and visual impairment (VI) in sub-Saharan Africa (SSA). METHODS A systematic review of population-based studies published between 2000 and October 2012. Prevalence and proportions of blindness and VI due to cataract, cataract surgical coverage (CSC), per cent intraocular lens (IOL) implantation and visual outcomes of surgery in accordance with WHO criteria were ascertained. RESULTS Data from 17 surveys (subjects mostly aged ≥ 50-years-old) from 15 different countries in SSA were included, comprising 96 402 people. Prevalence of blindness (presenting visual acuity <3/60 in better eye) ranged from 0.1% in Uganda to 9.0% in Eritrea, and the proportion of total blindness due to cataract ranged between 21% and 67%. Cataract was the principal cause of blindness and VI in 15 and 14 studies, respectively. There was a strong positive correlation between good visual outcomes and IOL use (R=0.69, p=0.027). Considerable inter-study heterogeneity was evident in CSC and visual outcomes following surgery, and between 40% and 100% of operations had used IOL. CONCLUSIONS Cataract represents the principal cause of blindness and VI and should remain a priority objective for eye care in SSA. However, the prevalence of blindness and VI due to cataract was variable and may reflect differences in the availability of cataract surgical programmes and cataract incidence.
Collapse
Affiliation(s)
- Andrew Bastawrous
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, , London, UK
| | | | | |
Collapse
|
23
|
Tsinopoulos IT, Lamprogiannis LP, Tsaousis KT, Mataftsi A, Symeonidis C, Chalvatzis NT, Dimitrakos SA. Surgical outcomes in phacoemulsification after application of a risk stratification system. Clin Ophthalmol 2013; 7:895-9. [PMID: 23717035 PMCID: PMC3663436 DOI: 10.2147/opth.s42726] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The purpose of this study was to determine whether application of a risk stratification system during preoperative assessment of cataract patients and subsequent allocation of patients to surgeons with matching experience may reduce intraoperative complications. Methods Nine hundred and fifty-three consecutive patients (1109 eyes) undergoing phacoemulsification cataract surgery were assigned to two groups, ie, group A (n = 498 patients, 578 eyes) and group B (n = 455 patients, 531 eyes). Patients from group A were allocated to surgeons with varying experience with only a rough estimate of the complexity of their surgery. Patients from group B were assigned to three risk groups (no added risk, low risk, and moderate-high risk) according to risk factors established during their preoperative assessment and were respectively allocated to resident surgeons, low-volume surgeons, or high-volume surgeons. Data were collected and entered into a computerized database. The intraoperative complication rate was calculated for each group. Results The intraoperative complication rate was significantly lower in group B than in group A (group A, 5.88%; group B, 3.2%; P < 0.05). Patients from group B with no added risk and allocated to resident surgeons had a significantly lower rate of intraoperative complications than those from group A allocated to resident surgeons (group A, 7.2%; group B, 3.08%; P < 0.05). Conclusion Our study demonstrates that allocation of cataract patients to surgeons matched for experience according to a uniform and reliable preoperative assessment of their risk of complications allows for better surgical outcomes, especially for resident surgeons.
Collapse
Affiliation(s)
- Ioannis T Tsinopoulos
- Second Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | | | | | | | | | | |
Collapse
|