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Liu R, Sule AA, Shannon CS, Ravilla T, Taylor H, Rojas-Carabali W, Khanna RC, Mishra C, Sen A, Khatri A, Tan ACS, Sobrin L, Agrawal R. A practical model for effective eye care delivery in Southeast Asian rural communities: A proposal built based on experts' recommendations. Indian J Ophthalmol 2024; 72:S473-S481. [PMID: 38648455 PMCID: PMC467020 DOI: 10.4103/ijo.ijo_2196_23] [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: 08/14/2023] [Revised: 11/10/2023] [Accepted: 01/03/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE To evaluate rural community-based eye care models from the perspective of community ophthalmology experts and suggest sustainable technological solutions for enhancing rural eye care delivery. METHODS A semi-structured descriptive survey, using close-ended and open-ended questions, was administered to the experts in community ophthalmology sourced through purposive sampling. The survey was self-administered and was facilitated through online platforms or in-person meetings. Uniform questions were presented to all participants, irrespective of their roles. RESULTS Surveyed participants (n = 22 with 15 from India and 7 from Nepal) in high-volume tertiary eye hospitals faced challenges with resources and rural outreach. Participants had mixed satisfaction with pre-operative screening and theatre resources. Delayed presentations and inexperienced surgeons contributed to the surgery complications. Barriers to rural eye care included resource scarcity, funding disparities, and limited infrastructure. In rural/peri-urban areas 87% of participants agreed with providing primary eye care services, with more than 60% of the experts not in agreement with the makeshift center model of eye care delivery. Key components for an effective eye care model are sustainability, accessibility, affordability, and quality. These can be bolstered through a healthcare management platform and a human-chain supply distribution system. CONCLUSION Tailored interventions are crucial for rural eye care, emphasizing the need for stronger human resources, optimized funding, and community awareness. Addressing challenges pertinent to delayed presentation and surgical training is vital to minimizing complications, especially with advanced cataracts. Enhancements in rural eye care demand a comprehensive approach prioritizing accessibility, affordability, and consistent quality.
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Affiliation(s)
- Renee Liu
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Ashita A Sule
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Choo Sheriel Shannon
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | - Hugh Taylor
- Indigenous Eye Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - William Rojas-Carabali
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Singapore
| | - 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, Telangana, India
| | | | - Alok Sen
- Sadguru Netra Chikatsalaya, Sri Sadguru Seva Sangh Trust, Chitrakoot, Madhya Pradesh, India
| | | | - Anna C S Tan
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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Subburaman GBB, Gunasekaran A, Chandrashekaran S, Ravindran RD, van Merode F, Balakrishnan L, Ravilla T, Gupta S. Comparison of cataract surgery outcomes between a secondary and a tertiary eye hospital in Tamil Nadu, India. Eye (Lond) 2024; 38:335-342. [PMID: 37553356 PMCID: PMC10811324 DOI: 10.1038/s41433-023-02687-6] [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: 11/14/2022] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE To examine the difference in post-operative visual outcomes of cataract surgeries between a tertiary and secondary centre at Aravind Eye Hospitals in Tamil Nadu, India. METHODS Our retrospective cross-sectional study analysed cataract surgeries at a secondary centre and its associated tertiary centre in 2021. Our main outcome measures were postoperative best corrected visual acuity (BCVA), spherical equivalent, and intraoperative and postoperative complications. Two-sample proportion tests and logistic regression analyses were performed. RESULTS The analysis of 32,302 cataract surgeries in 2021 of which 4357 were performed at the secondary centre and 27,945 were performed at the tertiary centre showed that the tertiary centre operated on more advanced cataract condition (p < 0.001). Intraoperative (p < 0.001) and post-operative complication rates (p < 0.001) were higher in the tertiary centre. The odds of effective outcomes (BCVA > = 6/12) controlling for all covariates are poorer (p < 0.0001) in the tertiary centre for both phacoemulsification (phaco) and manual small incision cataract surgeries (MSICS). CONCLUSION World Health Organization recommendations for the effective outcome of cataract surgery are met by both the tertiary and secondary centres, but the odds of effective outcomes in the tertiary centre was lower after adjusting for all known factors. Further investigations of the causes of poor vision in both phaco and MSICS in the tertiary centre are needed to improve the situation.
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Affiliation(s)
- Ganesh-Babu Balu Subburaman
- LAICO, Aravind Eye Care System, Madurai, India.
- Care and Public Health Research Institute (CAPHRI), Maastricht University / Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | | | | | | | - Frits van Merode
- Care and Public Health Research Institute (CAPHRI), Maastricht University / Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | | | - Sachin Gupta
- SC Johnson College of Business, Cornell University, Ithaca, NY, USA
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Chan VF, Yard E, Mashayo E, Mulewa D, Drake L, Omar F. Contextual factors affecting integration of eye health into school health programme in Zanzibar: a qualitative health system research. BMC Health Serv Res 2023; 23:1414. [PMID: 38098051 PMCID: PMC10722834 DOI: 10.1186/s12913-023-10469-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Short-term school eye health programmes supported by external funders have sustainability issues. This study aimed to understand the contextual factors affecting integrating eye health into the school health programme. METHODS We elicited responses from 83 respondents, purposefully selected from the Ministry of Health (n = 7), Ministry of Education and Vocational Training (n = 7), hospitals/eye centres (n = 5), master trainers (4) and schools (n = 60) who participated in in-depth interviews. Their responses were analysed and grouped into contextual factors according to the WHO Consolidated Framework for Implementation Research: stakeholders/political, institutional, physical, cultural, delivery system and others. Themes were then generated, and quotations were presented to illustrate the findings. RESULTS The six contextual factors affecting the integration of eye health into the school eye health programme were i) Stakeholders/political (Good ministry coordination, defined departmental roles and resource mobilisation from multiple stakeholders; Good stakeholder synergies and address current gaps); ii) Institutional (Institutional coordination and adequate clinic space; Securing human and financial resources; Strategic advocacy for institutional resources); iii) Physical (Long travel distance to service points); vi) Cultural (low eye health awareness among parents, teachers and children); iv) Delivery system (Practical approach to increase screening coverage using teachers as screeners; Balance teachers' workload, increase screening sensitivity and follow up and; v) Others (Comprehensive training material and effective training delivery; Improved curriculum, teacher selection and supervision and incentives). CONCLUSION Integrated school eye health delivery is generally well-received by stakeholders in Zanzibar, with the caveat that investment is required to address the six contextual factors identified in the study.
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Affiliation(s)
- Ving Fai Chan
- Centre of Public Health, School of Medicine, Dentistry and Biomedical Medicine, Royal Victoria Hospital, Institute of Clinical Sciences, Queen's University of Belfast, Block B, Belfast, BT12 6BA, UK.
- Brien Holden Vision Institute Foundation Africa Trust, Durban, South Africa.
- University of KwaZulu Natal, Durban, South Africa.
| | - Elodie Yard
- Partnership for Child Development, Imperial College London, London, UK
- Oriole Global Health, Nairobi, Kenya
| | - Eden Mashayo
- Brien Holden Vision Institute Foundation Africa Trust, Durban, South Africa
| | - Damaris Mulewa
- Partnership for Child Development, Imperial College London, London, UK
| | - Lesley Drake
- Partnership for Child Development, Imperial College London, London, UK
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Urizar MP, Gambra E, de Castro A, de la Peña Á, Pascual D, Cetinkaya O, Marcos S, Curatolo A. Long-range frequency-domain optical delay line based on a spinning tilted mirror for low-cost ocular biometry. BIOMEDICAL OPTICS EXPRESS 2023; 14:6521-6541. [PMID: 38420323 PMCID: PMC10898555 DOI: 10.1364/boe.501889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 03/02/2024]
Abstract
Optical biometers are routinely used to measure intraocular distances in ophthalmic applications such as cataract surgery planning or myopia monitoring. However, due to their high cost and reduced transportability, access to them for screening and surgical planning is still limited in low-resource and remote settings. To increase patients' access to optical biometry we propose a novel low-cost frequency-domain optical delay line (FD-ODL) based on an inexpensive stepper motor spinning a tilted mirror, for integration into a time-domain (TD)-biometer, amenable to a compact footprint. In the proposed FD-ODL, the axial scan range and the A-scan rate are decoupled from one another, as the former only depends on the spinning mirror tilt angle, while the A-scan rate only depends on the motor shaft rotational speed. We characterized the scanning performance and specifications for two spinning mirror tilt angles, and compared them to those of the standard, more expensive FD-ODL implementation, employing a galvanometric scanner for group delay generation. A prototype of the low-cost FD-ODL with a 1.5 deg tilt angle, resulting in an axial scan range of 6.61 mm and an A-scan rate of 10 Hz was experimentally implemented and integrated in a dual sample beam optical low-coherence reflectometry (OLCR) setup with a detour unit to replicate the measurement window around the anterior segment and the retina. The intraocular distances of a model eye were measured with the proposed low-cost biometer and found to be in good agreement with those acquired by a custom swept-source optical coherence tomography (SS-OCT) system and two commercial biometers, validating our novel design.
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Affiliation(s)
- María Pilar Urizar
- 2EyesVision S.L., Madrid, Spain
- Instituto de Óptica ‘Daza de Valdés’, Consejo Superior de Investigaciones Científicas (IO, CSIC), Madrid, Spain
| | | | - Alberto de Castro
- Instituto de Óptica ‘Daza de Valdés’, Consejo Superior de Investigaciones Científicas (IO, CSIC), Madrid, Spain
| | - Álvaro de la Peña
- Instituto de Óptica ‘Daza de Valdés’, Consejo Superior de Investigaciones Científicas (IO, CSIC), Madrid, Spain
| | - Daniel Pascual
- Instituto de Óptica ‘Daza de Valdés’, Consejo Superior de Investigaciones Científicas (IO, CSIC), Madrid, Spain
| | - Onur Cetinkaya
- International Centre for Translational Eye Research (ICTER), and Institute of Physical Chemistry, Polish Academy of Sciences (IPC-PAS), Warsaw, Poland
| | - Susana Marcos
- Instituto de Óptica ‘Daza de Valdés’, Consejo Superior de Investigaciones Científicas (IO, CSIC), Madrid, Spain
- The Institute of Optics and Flaum Eye Institute, Center for Visual Sciences, University of Rochester, New York, USA
| | - Andrea Curatolo
- Instituto de Óptica ‘Daza de Valdés’, Consejo Superior de Investigaciones Científicas (IO, CSIC), Madrid, Spain
- International Centre for Translational Eye Research (ICTER), and Institute of Physical Chemistry, Polish Academy of Sciences (IPC-PAS), Warsaw, Poland
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Cesak O, Vostalova J, Vidlar A, Bastlova P, Student V. Carnosine and Beta-Alanine Supplementation in Human Medicine: Narrative Review and Critical Assessment. Nutrients 2023; 15:nu15071770. [PMID: 37049610 PMCID: PMC10096773 DOI: 10.3390/nu15071770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
The dipeptide carnosine is a physiologically important molecule in the human body, commonly found in skeletal muscle and brain tissue. Beta-alanine is a limiting precursor of carnosine and is among the most used sports supplements for improving athletic performance. However, carnosine, its metabolite N-acetylcarnosine, and the synthetic derivative zinc-L-carnosine have recently been gaining popularity as supplements in human medicine. These molecules have a wide range of effects—principally with anti-inflammatory, antioxidant, antiglycation, anticarbonylation, calcium-regulatory, immunomodulatory and chelating properties. This review discusses results from recent studies focusing on the impact of this supplementation in several areas of human medicine. We queried PubMed, Web of Science, the National Library of Medicine and the Cochrane Library, employing a search strategy using database-specific keywords. Evidence showed that the supplementation had a beneficial impact in the prevention of sarcopenia, the preservation of cognitive abilities and the improvement of neurodegenerative disorders. Furthermore, the improvement of diabetes mellitus parameters and symptoms of oral mucositis was seen, as well as the regression of esophagitis and taste disorders after chemotherapy, the protection of the gastrointestinal mucosa and the support of Helicobacter pylori eradication treatment. However, in the areas of senile cataracts, cardiovascular disease, schizophrenia and autistic disorders, the results are inconclusive.
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Affiliation(s)
- Ondrej Cesak
- Department of Urology, University Hospital Olomouc, 775 20 Olomouc, Czech Republic
- Faculty of Medicine and Dentistry, Palacky University, 775 15 Olomouc, Czech Republic
| | - Jitka Vostalova
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacky University, 775 15 Olomouc, Czech Republic
| | - Ales Vidlar
- Department of Urology, University Hospital Olomouc, 775 20 Olomouc, Czech Republic
- Faculty of Medicine and Dentistry, Palacky University, 775 15 Olomouc, Czech Republic
| | - Petra Bastlova
- Department of Rehabilitaion, University Hospital Olomouc, 775 20 Olomouc, Czech Republic
| | - Vladimir Student
- Department of Urology, University Hospital Olomouc, 775 20 Olomouc, Czech Republic
- Faculty of Medicine and Dentistry, Palacky University, 775 15 Olomouc, Czech Republic
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Flessa S. Cataract Surgery in Low-Income Countries: A Good Deal! Healthcare (Basel) 2022; 10:healthcare10122580. [PMID: 36554103 PMCID: PMC9778186 DOI: 10.3390/healthcare10122580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Cataract is a major cause of blindness worldwide. In particular, in low-income countries, the burden of disease as well as its direct and indirect economic cost are a major challenge for the population and economy. In many cases, it would be possible to prevent or cure blindness with a comparably simple cataract surgery, but many countries lack the resources to strengthen healthcare systems and implement broad cataract surgery programs reaching, in particular, the rural poor. In this paper, we analyse whether such an intervention could be cost-effective or even cost-saving for the respective health systems. We calculate the net value of the lifelong costs of cataract with and without surgery. This calculation includes direct costs (e.g., treatment, glasses, surgery) as well as indirect cost of the caregiver and the patient. We total all costs from the year of onset of cataract until death and discount the respective values to the year of onset. We define the surgery as cost-saving if the net-value of costs with surgery is lower than without surgery. If the cost per quality adjusted life year is lower than one gross national product per capita, we define the intervention as highly cost-effective. We find that the cost-effectiveness of cataract surgery depends on the age of onset of the disease and the age of surgery. If the surgery is performed with the beginning of severe impairment, even surgery of a 78-year-old patient is still cost-saving. Almost all possible constellations are highly cost-effective, only for the very old it is questionable whether the surgery should be performed. The simulations show that cataract surgery is one of the most cost-effective interventions. However, millions of people in low-income countries still have no chance to prevent or cure blindness due to limited resources. The findings of this paper clearly call for a stronger effort to reach poor and rural populations with this cost-effective service.
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Affiliation(s)
- Steffen Flessa
- Department of Health Care Management, Faculty of Law and Economics, University of Greifswald, 17487 Greifswald, Germany
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7
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Malik M, Strang N, Campbell P, Jonuscheit S. Exploring eye care pathways, patient priorities and economics in Pakistan: A scoping review and expert consultation study with thematic analysis. Ophthalmic Physiol Opt 2022; 42:694-716. [PMID: 35318687 PMCID: PMC9310639 DOI: 10.1111/opo.12977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
Purpose As the prevalence of eye diseases increases, demand for effective, accessible and equitable eye care grows worldwide. This is especially true in lower and middle‐income countries, which have variable levels of infrastructure and economic resources to meet this increased demand. In the present study we aimed to review the literature on eye care in Pakistan comprehensively, with a particular focus on eye care pathways, patient priorities and economics. Methods A systematic scoping review was performed to identify literature relating to eye care in Pakistan. Searches of relevant electronic databases and grey literature were carried out. The results were analysed through a mixed methods approach encompassing descriptive numerical summary and thematic analysis. To consolidate results and define priority areas for future study, expert consultation exercises with key stakeholders were conducted using qualitative semi‐structured interviews. Results One hundred and thirty‐two papers (published and unpublished) were included in the final review. The majority (n = 93) of studies utilised a quantitative design. Seven interlinked themes were identified: eye care pathways, burden of eye disease, public views on eye‐related issues, workforce, barriers to uptake of eye care services, quality of eye care services and economic impact of blindness. Research priorities included investigating the eye care workforce, the quality and efficiency of current eye care services, eye care services available in rural Pakistan and the costs and benefits related to eye care provision and sustaining eye care programmes. Conclusions To the best of our knowledge, this is the first review to synthesise evidence from papers across the field relating to eye care in Pakistan. As such, this work provides new insights into the achievements of the national eye health programme, challenges in eye care in Pakistan and priority areas for future research.
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Affiliation(s)
- Manal Malik
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Niall Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Sven Jonuscheit
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
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Song Y, Overmass M, Fan J, Hodge C, Sutton G, Lovicu FJ, You J. Application of Collagen I and IV in Bioengineering Transparent Ocular Tissues. Front Surg 2021; 8:639500. [PMID: 34513910 PMCID: PMC8427501 DOI: 10.3389/fsurg.2021.639500] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/26/2021] [Indexed: 12/13/2022] Open
Abstract
Collagens represent a major group of structural proteins expressed in different tissues and display distinct and variable properties. Whilst collagens are non-transparent in the skin, they confer transparency in the cornea and crystalline lens of the eye. There are 28 types of collagen that all share a common triple helix structure yet differ in the composition of their α-chains leading to their different properties. The different organization of collagen fibers also contributes to the variable tissue morphology. The important ability of collagen to form different tissues has led to the exploration and application of collagen as a biomaterial. Collagen type I (Col-I) and collagen type IV (Col-IV) are the two primary collagens found in corneal and lens tissues. Both collagens provide structure and transparency, essential for a clear vision. This review explores the application of these two collagen types as novel biomaterials in bioengineering unique tissue that could be used to treat a variety of ocular diseases leading to blindness.
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Affiliation(s)
- Yihui Song
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Morgan Overmass
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jiawen Fan
- Key Laboratory of Myopia of State Health Ministry, Department of Ophthalmology and Vision Sciences, Eye and Ear, Nose, and Throat (ENT) Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chris Hodge
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- New South Wales (NSW) Tissue Bank, Sydney, NSW, Australia
- Vision Eye Institute, Chatswood, NSW, Australia
| | - Gerard Sutton
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- New South Wales (NSW) Tissue Bank, Sydney, NSW, Australia
- Vision Eye Institute, Chatswood, NSW, Australia
| | - Frank J. Lovicu
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Discipline of Anatomy and Histology, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Jingjing You
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
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Ravindran RD, Gupta S, Haripriya A, Ravilla T, S AV, Subburaman GBB. Seven-year trends in cataract surgery indications and quality of outcomes at Aravind Eye Hospitals, India. Eye (Lond) 2021; 35:1895-1903. [PMID: 32913291 PMCID: PMC8225659 DOI: 10.1038/s41433-020-0954-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To report trends in cataract surgery indications, visual acuity outcomes, complication rates and reoperation rates at ten Aravind Eye Hospitals in Tamil Nadu, India. METHODS In this retrospective database study we analyzed seven years of data of cataract surgeries at Aravind during January 1, 2012 to December 31, 2018. Our main outcome measures were preoperative and 1-month postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA); and rates of intraoperative complications and reoperations. We performed Cochran-Armitage trend tests. RESULTS In 1.86 million eyes that underwent cataract surgery, the percentage of eyes undergoing phacoemulsification (PE) showed an increasing trend (p < 0.0001), from 26.8% in 2012 to 33.5% in 2018. The percentage of eyes undergoing manual small incision cataract surgery (SICS) showed a decreasing trend (p < 0.0001), from 70.0% in 2012 to 65.1% in 2018. For SICS, the percentages of eyes with good postoperative UCVA and BCVA showed increasing trends (p < 0.0001 for each), and the percentages of eyes with poor postoperative UCVA and BCVA showed decreasing trends (p < 0.0001 for each). Results for PE surgeries were mixed. For both PE and SICS rates of intraoperative complications showed a declining trend (p < 0.0001 for each) and a slight increasing trend for reoperations (PE p < 0.02; SICS p < 0.0001). CONCLUSIONS During this seven-year period there were noticeable trends in cataract surgeries performed at Aravind in terms of the mix of surgical procedures, preoperative vision, and cataract surgical outcomes.
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Affiliation(s)
| | - Sachin Gupta
- SC Johnson College of Business, Cornell University, Ithaca, NY, USA
| | | | | | - Ashok Vardhan S
- Cataract Services, Sri Venkateswara Aravind Eye Hospital, Tirupati, India
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10
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Antwi-Adjei EK, Owusu E, Kobia-Acquah E, Dadzie EE, Anarfi E, Wanye S. Evaluation of postoperative refractive error correction after cataract surgery. PLoS One 2021; 16:e0252787. [PMID: 34138900 PMCID: PMC8211256 DOI: 10.1371/journal.pone.0252787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/21/2021] [Indexed: 11/25/2022] Open
Abstract
Suboptimal cataract surgery outcomes remain a challenge in most developing countries. In Ghana, about 2 million people have been reported to be blind due to cataract with about 20% new cases being recorded yearly. The aim of this study was to evaluate postoperative correction of refractive errors after cataract surgery in a selected eye hospital in Ashanti Region, Ghana. This was a retrospective study where medical records of patients (aged 40–100) who reported to an eye hospital in Ghana from 2013–2018 were reviewed. Included in the study were patients aged ≥40 years and patients with complete records. Data on patient demographics, type of surgery, intra-ocular lens (PCIOL) power, availability of biometry, postoperative refraction outcomes, pre- and postoperative visual acuity were analyzed. Data of two hundred and thirteen eyes of 190 patients who met the inclusion criteria were analyzed. Descriptive analysis and Chi-square test were carried out to determine the mean, median, standard deviation and relevant associations. The mean ± SD age was 67.21±12.2 years (51.2% were females). Small Incision Cataract Surgery (99.5%) with 100% IOL implants was the main cataract surgery procedure in this study. Pre-operative biometry was performed for 38.9% of all patients on their first eye surgery and 41.5% for second eye surgeries. About 71% eyes in this study were blind (presenting VA<3/60) before surgery; 40.4% had post-operative VA <3/60. Pre-existing ocular comorbidities discovered post- surgery, attributed to suboptimal visual outcomes. More than half (55.3%) of patients did not undergo postoperative refraction due to loss to follow-up. Year of surgery (p = .017), follow up visits< 2months (p < .0001) and discovered comorbidity post-surgery (p = .035) were the factors significantly associated with postoperative refraction. Myopia and compound myopic astigmatism were the dominant refractive error outcomes. The timing of post-operative refraction had a significant effect on postoperative refraction done. These findings indicate a clinically meaningful significance between completion of postoperative care and postoperative refraction done. Consequently, with settings in most developing countries, where less biometry is done, it is appropriate that post-operative refractive services are encouraged and done earlier to enhance the patients’ expectations while increasing cataract surgery patronage.
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Affiliation(s)
- Ellen Konadu Antwi-Adjei
- Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- * E-mail: ,
| | - Emmanuel Owusu
- Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Kobia-Acquah
- Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuella Esi Dadzie
- Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Anarfi
- Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Berges AJ, Baam ZR, Zhu A, Sikder S, Yiu S, Ravindran RD, Parikh KS. Addressing the MSICS learning curve: identification of instrument-holding techniques used by experienced surgeons. Int J Ophthalmol 2021; 14:693-699. [PMID: 34012883 DOI: 10.18240/ijo.2021.05.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To identify instrument holding archetypes used by experienced surgeons in order to develop a universal language and set of validated techniques that can be utilized in manual small incision cataract surgery (MSICS) curricula. METHODS Experienced cataract surgeons performed five MSICS steps (scleral incision, scleral tunnel, side port, corneal tunnel, and capsulorhexis) in a wet lab to record surgeon hand positions. Images and videos were taken during each step to identify validated hand position archetypes. RESULTS For each MSICS step, one or two major archetypes and key modifying variables were observed, including tripod for scleral incision, tripod-thumb bottom for scleral tunnel, underhand-index to thumb grip for side port, index-contact tripod for corneal entry, and tripod-forceps for capsulorhexis. Key differences were noted in thumb placement and number of fingers supporting the instrument, and modifying variables included index finger curvature and amount of flexion. CONCLUSION Identification of optimal hand positions and development of a formal nomenclature has the potential to help trainees adopt hand positions in an informed manner, influence instrument design, and improve surgical outcomes.
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Affiliation(s)
| | - Zervin R Baam
- Aravind Eye Hospital, Madurai, Tamil Nadu 625001, India
| | - Angela Zhu
- Wilmer Eye Institute, Baltimore, MD 21287, USA
| | - Shameema Sikder
- Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Wilmer Eye Institute, Baltimore, MD 21287, USA
| | - Samuel Yiu
- Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Wilmer Eye Institute, Baltimore, MD 21287, USA.,Center for Nanomedicine, Baltimore, MD 21231, USA
| | | | - Kunal S Parikh
- Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Wilmer Eye Institute, Baltimore, MD 21287, USA.,Center for Nanomedicine, Baltimore, MD 21231, USA.,Department of Biomedical Engineering, Baltimore, MD 21218, USA.,Center for Bioengineering Innovation & Design, Baltimore, MD 21218, USA
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12
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Geary A, Wen Q, Adrianzén R, Congdon N, Janani R, Haddad D, Timbo CS, Khalifa YM. The impact of distance cataract surgical wet laboratory training on cataract surgical competency of ophthalmology residents. BMC MEDICAL EDUCATION 2021; 21:219. [PMID: 33874941 PMCID: PMC8054504 DOI: 10.1186/s12909-021-02659-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND This study assessed the impact of distance cataract surgical wet laboratory training on surgical competency of ophthalmology residents at a tertiary-level ophthalmic training center in Trujillo, Peru. METHODS Three five-week distance wet lab courses were administered through Cybersight, Orbis International's telemedicine platform. Weekly lectures and demonstrations addressed specific steps in phacoemulsification surgery. Each lecture had two accompanying wet lab assignments, which residents completed and recorded in their institution's wet lab and uploaded to Cybersight for grading. Competency was assessed through anonymous grading of pre- and post-training surgical simulation videos, masked as to which occurred before and after training, using a standardized competency rubric adapted from the Ophthalmology Surgical Competency Assessment Rubric (OSCAR, scale of 0-32). Day one best-corrected post-operative visual acuity (BVCA) was assessed in the operative eye on the initial consecutive 4-6 surgeries conducted by the residents as per the norms of their residency training. An anonymous post-training satisfaction survey was administered to trainees'. RESULTS In total, 21 ophthalmic residents participated in the courses, submitting a total of 210 surgical videos. Trainees' average competency score increased 6.95 points (95%CI [4.28, 9.62], SD = 5.01, p < 0.0001, two sample t-test) from 19.3 (95%CI [17.2, 21.5], SD = 4.04) to 26.3 (95%CI [24.2, 28.3], SD = 3.93). Visual acuity for 92% of post-training resident surgeries (n = 100) was ≥20/60, meeting the World Health Organization's criterion for good quality. CONCLUSIONS Structured distance wet lab courses in phacoemulsification resulted in significantly improved cataract surgical skills. This model could be applicable to locations where there are obstacles to traditional in-person training, such as the current COVID-19 pandemic.
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Affiliation(s)
- Amelia Geary
- Orbis International, 520 8th Avenue, Floor 12, New York, NY, 10018, USA.
| | - Qing Wen
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, Northern Ireland
| | - Rosa Adrianzén
- Instituto Regional de Oftalmología Javier Servat Univazo, Trujillo, La Libertad, Peru
- Universidad Nacional de Trujillo, Trujillo, La Libertad, Peru
| | - Nathan Congdon
- Orbis International, 520 8th Avenue, Floor 12, New York, NY, 10018, USA
| | - R Janani
- Aravind eye hospital, Madurai, Tamil Nadu, 625020, India
| | - Danny Haddad
- Orbis International, 520 8th Avenue, Floor 12, New York, NY, 10018, USA
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Jolley E, Cumaio M, Vilanculos A, Hassane I, Kimani K, Ogundimu K, Schmidt E. Changes in Eye Health and Service Coverage in Nampula, Mozambique between 2011 and 2018. Ophthalmic Epidemiol 2021; 29:91-99. [PMID: 33759697 DOI: 10.1080/09286586.2021.1900279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Globally, there are few examples of repeated eye health surveys to assess changes in prevalence and causes of visual impairment, and service coverage over time. Two separate, unlinked rapid assessments of avoidable blindness (RAAB) were conducted in Nampula province, Mozambique in 2011 and 2018. This paper reports the observed changes and examines how the trends differ for males and females.Methods: Standard RAAB methodology was used in both studies. Two-stage cluster sampling was used to generate random samples of adults aged over 50 years. Participants underwent a simplified visual acuity (VA) exam, a lens exam and posterior segment exam using a direct ophthalmoscope for all subjects with presenting VA<6/18. Data were analysed using Stata and logistic regression models were developed to assess changes.Results: The 2011 study enrolled 3,050 people and examined 96.9% (2,954 people). The 2018 survey enrolled 4,191 people and examined 95.8% (4,015 people). Age- and sex-adjusted estimates of blindness decreased from 6.2% in 2011 to 4.5% in 2018 (z = -2.21, p = .028). Cataract surgical coverage was higher among males in both surveys (13.4% among males vs 7.7% among females in 2011, and 40.0% among males vs 19.4% among females in 2018) and the gender disparity grew between surveys.Conclusion: Significant changes were observed in the eye health and service coverage between 2011 and 2018. Further improvements to services are required to improve access for women and people with moderate visual impairment.
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Affiliation(s)
- Emma Jolley
- Evidence, Research & Innovations, Sightsavers, Haywards Heath, UK
| | | | | | | | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Elena Schmidt
- Evidence, Research & Innovations, Sightsavers, Haywards Heath, UK
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Kour A, Sharma S, Dube T, Bisht A, Sharma M, Mishra J, Ali ME, Panda JJ. l-3,4-Dihydroxyphenylalanine templated anisotropic gold nano/micro-roses as potential disrupters/inhibitors of α-crystallin protein and its gleaned model peptide aggregates. Int J Biol Macromol 2020; 163:2374-2391. [PMID: 32961180 DOI: 10.1016/j.ijbiomac.2020.09.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/25/2020] [Accepted: 09/16/2020] [Indexed: 11/26/2022]
Abstract
Cataract, the major cause of blindness worldwide occurs due to the misfolding and aggregation of the protein crystallin, which constitute a major portion of the lens protein. Other than the whole protein crystallin, the peptide sequences generated from crystallin as a result of covalent protein damage have also been shown to possess and foster protein aggregation, which can be established as crystallin aggregation models. Thus, the disaggregation or inhibition of these protein aggregates could be a viable approach to combat cataract and preserve lens proteostasis. Herein, we tried to explore the disruption as well as inhibition of the intact α-crystallin protein and α-crystallin derived model peptide aggregates by l-3,4-dihydroxyphenylalanine (levodopa) coated gold (Au) nano/micro-roses as modulators. Thioflavin T fluorescence enhancement assay, and electron microscopic analysis were being employed to probe the anti-aggregation behavior of the Au nano/micro-roses towards the aggregating α-crystallin peptides/protein. Further, computational studies were performed to reveal the nature of molecular interactions between the levodopa molecule and the α-crystallin derived model peptides. Interestingly, both levodopa coated Au nano/micro-roses were found to be capable of inhibiting as well as preventing the aggregation of the intact α-crystallin protein and other model peptides derived from it.
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Affiliation(s)
- Avneet Kour
- Institute of Nano Science and Technology, Mohali, Punjab 160062, India
| | - Shikha Sharma
- Institute of Nano Science and Technology, Mohali, Punjab 160062, India
| | - Taru Dube
- Institute of Nano Science and Technology, Mohali, Punjab 160062, India
| | - Anjali Bisht
- Institute of Nano Science and Technology, Mohali, Punjab 160062, India
| | - Manju Sharma
- Institute of Nano Science and Technology, Mohali, Punjab 160062, India
| | - Jibanananda Mishra
- School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Md Ehesan Ali
- Institute of Nano Science and Technology, Mohali, Punjab 160062, India
| | - Jiban Jyoti Panda
- Institute of Nano Science and Technology, Mohali, Punjab 160062, India.
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Yoshizaki M, Ramke J, Furtado JM, Burn H, Gichuhi S, Gordon I, Aghaji A, Marques AP, Dean WH, Congdon N, Buchan J, Burton MJ. Interventions to improve the quality of cataract services: protocol for a global scoping review. BMJ Open 2020; 10:e036413. [PMID: 32788187 PMCID: PMC7422650 DOI: 10.1136/bmjopen-2019-036413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Cataract is the leading cause of blindness globally and a major cause of vision impairment. Cataract surgery is an efficacious intervention that usually restores vision. Although it is one of the most commonly conducted surgical interventions worldwide, good quality services (from being detected with operable cataract to undergoing surgery and receiving postoperative care) are not universally accessible. Poor quality understandably reduces the willingness of people with operable cataract to undergo surgery. Therefore, it is critical to improve the quality of care to subsequently reduce vision loss from cataract. This scoping review aims to summarise the nature and extent of the published literature on interventions to improve the quality of services for primary age-related cataract globally. METHODS AND ANALYSIS We will search MEDLINE, Embase and Global Health for peer-reviewed manuscripts published since 1990, with no language, geographic or study design restrictions. To define quality, we have used the elements adopted by the WHO-effectiveness, safety, people-centredness, timeliness, equity, integration and efficiency-to which we have added the element of planetary health. We will exclude studies focused on the technical aspects of the surgical procedure and studies that only involve children (<18 years). Two reviewers will screen all titles/abstracts independently, followed by a full-text review of potentially relevant articles. For included articles, data regarding publication characteristics, study details and quality-related outcomes will be extracted by two reviewers independently. Results will be synthesised narratively and presented visually using a spider chart. ETHICS AND DISSEMINATION Ethical approval was not sought, as our review will only include published and publicly accessible information. We will publish our findings in an open-access peer-reviewed journal and develop an accessible summary of the results for website posting. A summary of the results will be included in the ongoing Lancet Global Health Commission on Global Eye Health. REGISTRATION DETAILS Open Science Framework (https://osf.io/8gktz).
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Affiliation(s)
- Miho Yoshizaki
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - João M Furtado
- Division of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
| | - Helen Burn
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Iris Gordon
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ada Aghaji
- Department of Ophthalmology, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ana P Marques
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - William H Dean
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Ophthalmology, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - John Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- Moorfields Eye Hospital, London, UK
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Nigam I, Keshari R, Vatsa M, Singh R, Bowyer K. Phacoemulsification Cataract Surgery Affects the Discriminative Capacity of Iris Pattern Recognition. Sci Rep 2019; 9:11139. [PMID: 31366988 PMCID: PMC6668423 DOI: 10.1038/s41598-019-47222-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/02/2019] [Indexed: 01/10/2023] Open
Abstract
Cataract is a common ophthalmic disorder and the leading cause of blindness worldwide. While cataract is cured via surgical procedures, its impact on iris based biometric recognition has not been effectively studied. The key objective of this research is to assess the effect of cataract surgery on the iris texture pattern as a means of personal authentication. We prepare and release the IIITD Cataract Surgery Database (CaSD) captured from 132 cataract patients using three commercial iris sensors. A non-comparative non-randomized cohort study is performed on the iris texture patterns in CaSD and authentication performance is studied using three biometric recognition systems. Performance is lower when matching pre-operative images to post-operative images (74.69 ± 9.77%) as compared to matching pre-operative images to pre-operative images (93.42 ± 1.76%). 100% recognition performance is observed on a control-group of healthy irises from 68 subjects. Authentication performance improves if cataract affected subjects are re-enrolled in the system, though re-enrollment does not ensure performance at par with pre-operative scenarios (86.67 ± 5.64%). The results indicate that cataract surgery affects the discriminative nature of the iris texture pattern. This finding raises concerns about the reliability of iris-based biometric recognition systems in the context of subjects undergoing cataract surgery.
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Geary A, Benavent S, Amador De La Cruz E, Wayman L. Distance Surgical Mentorship for Ophthalmologists in Northern Peru. MEDEDPUBLISH 2019; 8:45. [PMID: 38089381 PMCID: PMC10712597 DOI: 10.15694/mep.2019.000045.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Purpose: To evaluate the quality of live distance surgical mentorship as an alternative way to provide continuing professional development (CPD) to practicing ophthalmologists. An activity which could be particularly beneficial to surgeons in remote locations where CPD is difficult to access. Methods: Orbis paired ophthalmologists from the Regional Institute of Ophthalmology (IRO) in Trujillo, Peru and a senior ophthalmologist from Vanderbilt Eye Institute in Tennessee, USA (LW). One week in advance, the Peruvian surgeon sent the mentor patient information confidentially via Cybersight.org, Orbis' telemedicine platform. The mentor reviewed the preoperative information to determine if the case was appropriate for remote guidance and formulated questions to help guide the educational experience. The mentor and mentee also consulted on specific learning objectives. The mentor observed live phacoemulsification surgery over the Internet using audio-visual equipment and Zoom desktop video conferencing software, allowing her to see through the operating microscope in real-time and have constant voice contact with the local surgeon. Post-mentorship a survey was administered to gauge acceptability of the CPD method, as well as their self-assessment on its impact on their skill development. Results: Latency experienced was well within the suggested margin of acceptability and the video quality was broadcast-grade, allowing the mentor to clearly see the anatomy and instrument manipulation. Seven surgeons over four sessions performed twelve phacoemulsification surgeries in Peru, 91.67% of those 12 patients achieved postoperative best corrected visual acuity ≥6/18. Four surgeons completed the survey and 100% agreed or strongly agreed that their objectives had been met and that the CPD had increased their confidence and their surgical skills. The step in the procedure most commonly reported for improvement was nuclear cracking (75% of respondents), followed by hydrodissection, quadrant removal and wound closure (50% each). Conclusions: Distance surgical mentorship in phacoemulsification is an acceptable form of CPD for consultant ophthalmologists. We describe a program with positive user feedback and experiences of improved confidence and microsurgical skill among participants.
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Affiliation(s)
| | | | | | - Laura Wayman
- Department of Ophthalmology and Visual Sciences at Vanderbilt University Medical Center
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Wang L, Liu W, Huang X. An approach to revolutionize cataract treatment by enhancing drug probing through intraocular cell line. Libyan J Med 2018; 13:1500347. [PMID: 30045674 PMCID: PMC6070994 DOI: 10.1080/19932820.2018.1500347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The purpose of this study is to prepare and characterize solid lipid nanoparticles (SLN) of N-Acetyl Carnosine (NAC) to treat cataract since surgery necessitates equipments and professional help. Cataract is believed to be formed by the biochemical approach where the crystalline eye proteins lose solubility and forms high molecular weight masses. Added advantages of SLN of NAC (henceforth referred as SLN-NAC) in the study are reduced size, sustained release and better corneal penetration of drug. The method of preparation of SLN-NAC by Mill’s method is unique in itself. The size of the SLN-NAC was 75 ± 10 nm in the range of ideal for penetration. The in-vitro release study and the SLN-NAC formulations prepared with Mill’s method demonstrated sustained release up to 24 h following an initial burst after 1 h. The zeta potential of the prepared formulation was −22.1 ± 1 mV. Corneal permeation studies using goat corneas indicate that SLN-NAC penetration rate was higher than those from NAC eye drops. Corneal hydration studies indicated that the formulation caused no harm to the corneal cells. Therefore it may be concluded that SLN-NAC may revolutionize cataract treatment and reversal by improving drug permeation, reducing toxicity and no damage to corneal tissue.
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Affiliation(s)
- Ling Wang
- a Department of Ophthalmology , The First Affiliated Hospital of Hainan Medical College , Haikou , Hainan , China
| | - Weixian Liu
- a Department of Ophthalmology , The First Affiliated Hospital of Hainan Medical College , Haikou , Hainan , China
| | - Xionggao Huang
- a Department of Ophthalmology , The First Affiliated Hospital of Hainan Medical College , Haikou , Hainan , China
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de Almeida Ferreira G, Schaal LF, Ferro MD, Rodrigues ACL, Khandekar R, Schellini SA. Outcomes of and barriers to cataract surgery in Sao Paulo State, Brazil. BMC Ophthalmol 2017; 17:259. [PMID: 29273018 PMCID: PMC5741937 DOI: 10.1186/s12886-017-0637-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/28/2017] [Indexed: 12/04/2022] Open
Abstract
Background Cataract is the leading cause of blindness in developing countries and identification of the barriers to accessing treatment is essential for developing appropriate public healthcare interventions. To evaluate the barriers to cataract surgery after diagnosis and assess the postoperative outcomes in Sao Paolo State, Brazil. Methods This prospective study evaluated cataract patients from 13 counties in São Paulo State in 2014. Cataract was diagnosed in the community by a mobile ophthalmic unit and patients were referred to a hospital for management. Gender, age, distance to the hospital and local municipal health structure were evaluated as possible barriers. Data were analyzed for postoperative outcomes and the impact on blindness and visual impairment. Results Six hundred patients were diagnosed with cataract with a mean age of 68.8±10.3 years and 374 (62.3%) were females. Two hundred and fifty-four (42.3%) patients presented to the referral hospital. One hundred forty-four (56.7%) underwent surgery, 56 (22.0%) decided not to undergo surgery, 40 (15.7%) required only YAG-Laser and 14 (5.5%) required a spectacle prescription only. Visual acuity increased statistically significantly from 1.07±0.73 logMAR at presentation to 0.25±0.41 logMAR at the final visit after intraocular lens implantation (p=0.000). There was a statistically significantly decrease from 17 (11.8%) blind patients and 55 (38.2%) visually impaired patients at presentation to 2 (1.4%) and 5 (3.5%) patients respectively after treatment (p=0.000). Conclusion Less than half of the individuals with cataract presented to the hospital for surgery. Among the patients who underwent treatment, there was an overall decrease in the number of blind individuals and visually impaired individuals. The barriers to cataract surgery were older age, greater distance to the hospital, municipalities with fewer inhabitants and less ophthalmic services.
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Affiliation(s)
- Gabriel de Almeida Ferreira
- Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu Botucatu, Sao Paulo, Brazil
| | - Luisa Fioravanti Schaal
- Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu Botucatu, Sao Paulo, Brazil
| | - Marcela Dadamos Ferro
- Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu Botucatu, Sao Paulo, Brazil
| | | | - Rajiv Khandekar
- Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu Botucatu, Sao Paulo, Brazil
| | - Silvana Artioli Schellini
- Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu Botucatu, Sao Paulo, Brazil.
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Jorge PA, Koch CR, Jorge D, Kara-Junior N. Long-term efficiency of cataract surgery with hydrophilic acrylic Ioflex intraocular lens. Clinics (Sao Paulo) 2017; 72:543-546. [PMID: 29069257 PMCID: PMC5629703 DOI: 10.6061/clinics/2017(09)04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/16/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the efficiency of long-term cataract surgery using low-cost intraocular lens implantation in community campaigns. METHODS Fifty-eight randomly selected patients were evaluated four years after phacoemulsification and Ioflex intraocular lens implantation. Causes of low visual acuity related to the intraocular lens were evaluated, and treatment costs were calculated. RESULTS The mean age of patients was 72±10.2 years. Four years after surgery, 25 eyes (43.0%) had decreased visual acuity related to the intraocular lens: posterior capsule opacification was noted in 24 eyes (41.3%), and intraocular lens opacification was noted in one eye (1.7%). The total cost of the post-surgical complication treatments represented 6.3% of the initial budget of the entire surgical patient group. CONCLUSIONS The efficiency of cataract surgery with low-cost Ioflex intraocular lens implantation was significantly reduced in a long-term follow-up study because postoperative complications related to intraocular lenses emerged at higher rates than when the gold-standard treatment was used.
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Affiliation(s)
- Priscilla A. Jorge
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Camila Ribeiro Koch
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Delano Jorge
- Departamento de Oftalmologia, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Newton Kara-Junior
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Buchan JC, Dean WH, Foster A, Burton MJ. What are the priorities for improving cataract surgical outcomes in Africa? Results of a Delphi exercise. Int Ophthalmol 2017. [PMID: 28634930 PMCID: PMC6061020 DOI: 10.1007/s10792-017-0599-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The quality of cataract surgery delivered in sub-Saharan Africa (SSA) is a significant constraint to achieving the elimination of avoidable blindness. No published reports from routine SSA cataract services attain the WHO benchmarks for visual outcomes; poor outcomes (<6/60) often comprise 20% in published case series. This Delphi exercise aimed to identify and prioritise potential interventions for improving the quality of cataract surgery in SSA to guide research and eye health programme development. METHODS An initial email open-question survey created a ranked list of priorities for improving quality of surgical services. A second-round face-to-face discussion facilitated at a Vision 2020 Research Mentorship Workshop in Tanzania created a refined list for repeated ranking. RESULTS Seventeen factors were agreed that might form target interventions to promote quality of cataract services. Improved training of surgeons was the top-ranked item, followed by utilisation of biometry, surgical equipment availability, effective monitoring of outcomes of cataract surgery by the surgeon, and well-trained support staff for the cataract pathway (including nurses seeing post-operative cases). CONCLUSION Improving the quality of cataract surgery in SSA is a clinical, programmatic and public health priority. In the absence of other evidence, the collective expert opinion of those involved in ophthalmic services regarding the ranking of factors to promote quality improvement, refined through this Delphi exercise, provides us with candidate intervention areas to be evaluated.
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Affiliation(s)
- J C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - W H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - A Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - M J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Alasbali T, Lofty NM, Al-Gehaban S, Alkuraya HS, Alsharif AM, Khandekar R. Cataract Surgery Audit at a Private Hospital in Saudi Arabia. Middle East Afr J Ophthalmol 2015; 22:502-7. [PMID: 26692725 PMCID: PMC4660540 DOI: 10.4103/0974-9233.167820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: To assess the visual outcomes following cataract surgeries at a Private Eye Hospital in Riyadh, Saudi Arabia. Methods: This was a cohort study of cataract surgeries performed from January to June 2014. Preoperative data were collected on patient demographics presenting and best corrected distance visual acuity (BCVA) and ocular comorbidity. Data were also collected on the type of surgery, type of intraocular lens (IOLs) implanted, and complications. BCVA and refractive status at 6–8 weeks postoperatively were noted. The predictors of vision ≥6/18 were identified. Results: Four hundred eyes of 400 patients underwent cataract surgery. There were 235 (59%) males. Presenting preoperative vision was <6/60 in 52 (13%) eyes. There were 395 (99%) eyes that underwent IOL implantation following phacoemulsification and 4 eyes received a sulcus fixated IOL. A single piece aspheric IOL was implanted in 358 (90%) eyes and a toric IOL was implanted in 31 (8%) eyes. Postoperative BCVA was classified as a “good outcome” (≥6/18) in 320 (80%) and a “poor outcome” (<6/60) in 24 (6%) eyes. Young age (adjusted odds ratio (OR) = 0.97, P = 0.01), male (adjusted OR = 2.4, P = 0.002), and ocular co-morbidities (adjusted OR = 0.2, P < 0.001) were predictors of vision ≥6/18. Complications included a dropped nucleus and a posterior capsular tear in 2 eyes each. Two hundred and fifty-two (63%) eyes were emmetropic or intentionally myopic for distance. Astigmatism <2 D was present in 264 (66%) eyes and astigmatism >2 D was present in 33 (8%) eyes. Conclusion: The recent trend of intentional overcorrection in one eye following modern cataract surgery in order to provide some functional near vision indicates that benchmark for success in getting “good visual outcomes” postoperatively (vision of ≥6/18) may need to be revised.
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Affiliation(s)
- Tariq Alasbali
- Department of Ophthalmology, Imam Mohammed bin Saud Islamic University College of Medicine, Riyadh, Saudi Arabia ; Department of Ophthalmology, Specialised Medical Hospital, Riyadh, Saudi Arabia
| | - Nancy Maher Lofty
- Department of Ophthalmology, Imam Mohammed bin Saud Islamic University College of Medicine, Riyadh, Saudi Arabia
| | - Saeed Al-Gehaban
- Department of Ophthalmology, Imam Mohammed bin Saud Islamic University College of Medicine, Riyadh, Saudi Arabia
| | - Hisham S Alkuraya
- Department of Ophthalmology, Specialised Medical Hospital, Riyadh, Saudi Arabia
| | | | - Rajiv Khandekar
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Sonron EA, Tripathi V, Bridgemohan P, Sharma S. A retrospective study on the outcomes of cataract surgery in an Eastern Regional Health Authority hospital of Trinidad and Tobago. PeerJ 2015; 3:e1222. [PMID: 26357596 PMCID: PMC4562237 DOI: 10.7717/peerj.1222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/09/2015] [Indexed: 02/04/2023] Open
Abstract
Background. Worldwide, cataract is a major cause of blindness. The paper aims to evaluate factors associated with borderline and poor outcomes of cataract surgery at an Eastern Regional Health Authority (ERHA) hospital in Trinidad and Tobago. Materials and Methods. A hospital-based, retrospective study was done on 401 patients who had undergone cataract surgery (unilateral and bilateral) at an ERHA Hospital between March 2009 and September 2014. Data was collected on variables concerning demographic, medical history, surgical history, ocular findings and visual acuity (VA). The outcome variable of interest was Snellen's post-operative (presenting) VA which was transformed into a dichotomous variable with borderline and poor outcomes as one and good outcomes as the other. Data were analysed using univariate and multivariate logistic regression analyses. Results. Good outcome (presenting VA 6/18 or better) was seen in 350 (67%) eyes. The fitted model consisted of ocular co-morbidity (OR =2.133; 95% CI [1.346-3.380]), hypertension (OR = 0.520; 95% CI [0.381-0.928]), surgical procedure (OR = 1.56; 95% CI [1.004-2.425]), good preoperative VA (OR = 0.388, 95% CI [0.211-0.714]), borderline preoperative VA (OR = 0.485; 95% CI = [0.278-0.843]) and year of first visit to clinic (OR = 2.243; 95% CI [1.215-4.141]). Conclusion. There is a need for community-based outreach to increase awareness of eye health and diseases. It is recommended that the general population is encouraged to take responsibility for personal management. The facilities at the Hospital should also be enhanced.
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Affiliation(s)
- Ebiakpo-aboere Sonron
- Department of Mathematics & Statistics, Faculty of Science and Technology, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Vrijesh Tripathi
- Department of Mathematics & Statistics, Faculty of Science and Technology, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Petra Bridgemohan
- Ophthalmology Department, Sangre Grande Hospital, Eastern Regional Health Authority, Trinidad and Tobago
| | - Subash Sharma
- School of Optometry and Visual Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
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The Barrie Jones Lecture-Eye care for the neglected population: challenges and solutions. Eye (Lond) 2015; 29:30-45. [PMID: 25567375 DOI: 10.1038/eye.2014.239] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/02/2014] [Indexed: 11/09/2022] Open
Abstract
Globally, pockets of 'neglected populations' do not have access to basic health-care services and carry a much greater risk of blindness and visual impairment. While large-scale public health approaches to control blindness due to vitamin A deficiency, onchocerciasis, and trachoma are successful, other causes of blindness still take a heavy toll in the population. High-quality comprehensive eye care that is equitable is the approach that needs wide-scale application to alleviate this inequity. L V Prasad Eye Institute of India developed a multi-tier pyramidal model of eye care delivery that encompasses all levels from primary to advanced tertiary (quaternary). This has demonstrated the feasibility of 'Universal Eye Health Coverage' covering promotive, preventive, corrective, and rehabilitative aspects of eye care. Using human resources with competency-based training, effective and cost-effective care could be provided to many disadvantaged people.
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Lewallen S, Schmidt E, Jolley E, Lindfield R, Dean WH, Cook C, Mathenge W, Courtright P. Factors affecting cataract surgical coverage and outcomes: a retrospective cross-sectional study of eye health systems in sub-Saharan Africa. BMC Ophthalmol 2015; 15:67. [PMID: 26122748 PMCID: PMC4485868 DOI: 10.1186/s12886-015-0063-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 06/23/2015] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Recently there has been a great deal of new population based evidence on visual impairment generated in sub-Saharan Africa (SSA), thanks to the Rapid Assessment of Avoidable Blindness (RAAB) survey methodology. The survey provides information on the magnitude and causes of visual impairment for planning services and measuring their impact on eye health in administrative "districts" of 0.5-5 million people. The survey results describing the quantity and quality of cataract surgeries vary widely between study sites, often with no obvious explanation. The purpose of this study was to examine health system characteristics that may be associated with cataract surgical coverage and outcomes in SSA in order to better understand the determinants of reducing the burden of avoidable blindness due to cataract. METHODS This was a descriptive study using secondary and primary data. The outcome variables were collected from existing surveys. Data on potential district level predictor variables were collected through a semi-structured tool using routine data and key informants where appropriate. Once collected the data were coded and analysed using statistical methods including t-tests, ANOVA and the Kruskal-Wallis analysis of variance test. RESULTS Higher cataract surgical coverage was positively associated with having at least one fixed surgical facility in the area; availability of a dedicated operating theatre; the number of surgeons per million population; and having an eye department manager in the facility. Variables that were associated with better outcomes included having biometry and having an eye department manager in the facility. CONCLUSIONS There are a number of health system factors at the district level that seem to be associated with both cataract surgical coverage and post-operative visual acuity outcomes. This study highlights the needs for better indicators and tools by which to measure and monitor the performance of eye health systems at the district level. It is unlikely that epidemiological data alone is sufficient for planning eye health services within a district and health managers and study coordinators need to consider collecting supplementary information in order to ensure appropriate planning can take place.
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Affiliation(s)
- Susan Lewallen
- Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa.
| | - Elena Schmidt
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BW, West Sussex, UK.
| | - Emma Jolley
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BW, West Sussex, UK.
| | - Robert Lindfield
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
| | | | - Colin Cook
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa.
| | - Wanjiku Mathenge
- Rwanda International Institute of Ophthalmology and Dr Agarwal's Eye Hospital, Kigali, Rwanda.
| | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa.
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Lansingh VC, Eckert KA, Strauss G. Benefits and risks of immediately sequential bilateral cataract surgery: a literature review. Clin Exp Ophthalmol 2015; 43:666-72. [PMID: 25824813 DOI: 10.1111/ceo.12527] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/23/2015] [Indexed: 11/28/2022]
Abstract
Immediately sequential bilateral cataract surgery (ISBCS) is a highly contended issue in ophthalmology, mainly due to the risk of bilateral endophthalmitis and financial penalties that many ophthalmologists face when performing simultaneous cataract surgeries. The purpose of this review is to understand the current status of the knowledge of ISBCS, mainly its benefits and risks and how they compare with the standard of care, delayed sequential bilateral cataract surgery. Evidence, although limited, increasingly supports ISBCS for providing faster rehabilitation, improved visual outcomes, and cost and time savings. Evidence does not support the fear of bilateral endophthalmitis resulting from the simultaneous procedure. However, stronger and greater evidence is needed before ISBCSs can be considered the standard of care. Where ISBCS can potentially create the most beneficial impact is in public eye health programmes in developing countries, but this has not yet been explored.
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Affiliation(s)
- Van C Lansingh
- Instituto Mexicano de Oftalmología Circuito Exterior Estadio Corregidora S/N, Querétaro, Querétaro, Mexico.,Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennesee, USA.,HelpMeSee, New York, New York, USA
| | - Kristen A Eckert
- Independent Consultant in Prevention of Blindness, Tapachula, Chiapas, Mexico
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Lindfield R, Knight A, Bwonya D. An approach to assessing patient safety in hospitals in low-income countries. PLoS One 2015; 10:e0121628. [PMID: 25894554 PMCID: PMC4403808 DOI: 10.1371/journal.pone.0121628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/06/2015] [Indexed: 12/21/2022] Open
Abstract
Objective The aim of the study was to assess non-technical aspects of patient safety practices using non-participant observation in different clinical areas. Design Qualitative study using non-participant observation and thematic analysis. Setting Two eye care units in Uganda. Participants Staff members in each hospital. Main outcome measures A set of observations of patient safety practices by staff members in clinical areas that were then coded using thematic analysis. Results Twenty codes were developed that explained patient safety practices in the hospitals based on the observations. These were grouped into four themes: the team, the environment, patient-centred care and the process. The complexity of patient safety in each hospital was described using narrative reports to support the thematic analysis. Overall both hospitals demonstrated good patient safety practices however areas for improvement were staff-patient communication, the presence and use of protocols and a focus on consistent practice. Conclusions This is the first holistic assessment of patient safety practices in a low-income setting. The methods allowed the complexity of patient safety to be understood and explained with areas of concern highlighted. The next step will be to develop a useful and easy to use tool to measure patient safety practices in low-income settings.
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Affiliation(s)
- Robert Lindfield
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Abigail Knight
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Bwonya
- Ophthalmology Department, Ruharo Mission Hospital, Mbarara, Uganda
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Devendra J, Agarwal S, Singh PK. A Comparative Study of Clear Corneal Phacoemulsification with Rigid IOL Versus SICS; the Preferred Surgical Technique in Low Socio-economic group Patients of Rural Areas. J Clin Diagn Res 2014; 8:VC01-VC03. [PMID: 25584291 DOI: 10.7860/jcdr/2014/10717.5208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 09/09/2014] [Indexed: 11/24/2022]
Abstract
CONTEXT Low socio-economic group patients from rural areas often opt for free cataract surgeries offered by charitable organisations. SICS continues to be a time tested technique for cataract removal in such patients. In recent times, camp patients are sometimes treated by clear corneal phacoemulsification with implantation of a rigid IOL, which being more cost effective is often provided for camp patients. This study was undertaken to find out which surgical technique yielded better outcomes and was more suited for high volume camp surgery. AIM To find the better surgical option- phacoemulsification with rigid IOL or SICS, in poor patients from rural areas. SETTINGS AND DESIGN A prospective randomised controlled trial of cataract patients operated by two different techniques. MATERIALS AND METHODS One hundred and twelve eyes were selected and were randomly allocated into two groups of 56 eyes each. At completion of the study, data was analysed for 52 eyes operated by clear corneal phacoemulsification and implantation of a rigid IOL, and 56 eyes operated by SICS. STATISTICAL ANALYSIS USED Unpaired t-test was used to calculate the p- value. RESULTS The results were evaluated on the following criteria. The mean post-operative astigmatism at the end of four weeks - was significantly higher in phacoemulsification group as compared to SICS group The BCVA (best corrected visual acuity) at the end of four weeks - was comparable in both groups. Subjective complaints and/ or complications: In phaco group two patients required sutures and seven had striate keratitis , while none in SICS group. Complaint of irritation was similar in both groups. Surgical time- was less for SICS group as compared to phaco group. CONCLUSION SICS by virtue of being a faster surgery with more secure wound and significantly less astigmatism is a better option in camp patients from rural areas as compared to phacoemulsification with rigid IOL.
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Affiliation(s)
- Jaya Devendra
- Associate Professor, Department of Ophthalmology, Rohilkhand Medical College and Hospital , Bareilly, India
| | - Smita Agarwal
- Associate Professor, Department of Ophthalmology, Teerthankar Mahavir Medical College , Moradabad, India
| | - Pankaj Kumar Singh
- Associate Professor, Department of Anatomy, Rohilkhand Medical College and Hospital , Bareilly, India
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Foldable vs rigid lenses after phacoemulsification for cataract surgery: a randomised controlled trial. Eye (Lond) 2014; 28:567-75. [PMID: 24556879 DOI: 10.1038/eye.2014.26] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 01/15/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To compare the outcomes of phacoemulsification with either a 2.5-mm clear corneal incision and a foldable intraocular lens (IOL) or a 5-mm sclerocorneal tunnel incision and a rigid polymethyl methacrylate (PMMA) IOL. METHODS In a prospective, randomised clinical trial of phacoemulsification cataract surgery, 1200 patients received either a foldable hydrophilic acrylic IOL through a 2.5-mm corneal incision or an inexpensive rigid PMMA IOL via a 5-mm sclerocorneal tunnel. Intra- and post-operative data and visual acuity at discharge, 6 weeks, and 1 year follow-up were analysed. RESULTS At 1 year after surgery, 996 (83.0%) patients were followed up with an uncorrected visual acuity of 6/18 or better in 90.3% of the foldable and 94.3% in the rigid IOL group (risk ratio (RR) 0.96, 95% confidence intervals (CI) 0.92-0.99). Poor outcome (best-corrected acuity 6/60 or worse) occurred in 1.0% and 0.4%, respectively (RR 4.28, 95% CI 0.48-38.18). The surgical cost of consumables and overall surgical time were similar in both groups; however, the cost of the foldable IOL was eight times higher than the PMMA IOL. Posterior capsule opacification was more common in the rigid IOL group at 12 months (36.1% vs 23.3%); however, this did not affect post-operative vision. CONCLUSION In the hands of experienced cataract surgeons, phacoemulsification with implantation of a foldable or a rigid IOL gives excellent results. Using an inexpensive rigid PMMA IOL will make phacoemulsification more affordable for poor patients in low- and middle-income countries.
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du Toit R, Faal HB, Etya'ale D, Wiafe B, Mason I, Graham R, Bush S, Mathenge W, Courtright P. Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach. BMC Health Serv Res 2013; 13:102. [PMID: 23506686 PMCID: PMC3616885 DOI: 10.1186/1472-6963-13-102] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 03/02/2013] [Indexed: 12/03/2022] Open
Abstract
Background The impact of unmet eye care needs in sub-Saharan Africa is compounded by barriers to accessing eye care, limited engagement with communities, a shortage of appropriately skilled health personnel, and inadequate support from health systems. The renewed focus on primary health care has led to support for greater integration of eye health into national health systems. The aim of this paper is to demonstrate available evidence of integration of eye health into primary health care in sub-Saharan Africa from a health systems strengthening perspective. Methods A scoping review method was used to gather and assess information from published literature, reviews, WHO policy documents and examples of eye and health care interventions in sub-Saharan Africa. Findings were compiled using a health systems strengthening framework. Results Limited information is available about eye health from a health systems strengthening approach. Particular components of the health systems framework lacking evidence are service delivery, equipment and supplies, financing, leadership and governance. There is some information to support interventions to strengthen human resources at all levels, partnerships and community participation; but little evidence showing their successful application to improve quality of care and access to comprehensive eye health services at the primary health level, and referral to other levels for specialist eye care. Conclusion Evidence of integration of eye health into primary health care is currently weak, particularly when applying a health systems framework. A realignment of eye health in the primary health care agenda will require context specific planning and a holistic approach, with careful attention to each of the health system components and to the public health system as a whole. Documentation and evaluation of existing projects are required, as are pilot projects of systematic approaches to interventions and application of best practices. Multi-national research may provide guidance about how to scale up eye health interventions that are integrated into primary health systems.
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