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Woudstra-de Jong JE, Manning-Charalampidou SS, Vingerling H, Busschbach JJ, Pesudovs K. Patient-reported outcomes in patients with vitreous floaters: A systematic literature review. Surv Ophthalmol 2023; 68:875-888. [PMID: 37315741 DOI: 10.1016/j.survophthal.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023]
Abstract
Seeking treatment for bothersome vitreous floaters is patient driven. To measure the impact of floaters and treatment on an individual's quality of life, patient-reported outcome measurements (PROMs) are essential. We review all studies using a PROM for patients with floaters. We evaluated content coverage against quality-of-life domains previously identified in other ophthalmic disorders, and against a qualitative study investigating quality-of-life issues in patients with floaters. We assessed measurement properties of PROMs using an extensive range of psychometric quality criteria. We identified 59 studies using 28 different PROMs. Many PROMs were not specifically developed for patients with floaters. Floater-specific PROMs were mostly based on content validation from an ophthalmologist or researcher perspective; two included a patient perspective. Using the outcomes of the qualitative study, we found that the floater-specific PROMs were narrow in their content coverage, with most items relating to visual symptoms and activity limitations. Testing the psychometric quality of PROMs was rare, and when employed mostly limited to responsiveness and known group validity. The remarkable high number of floater-specific PROMs reveals a need for such measurements in ophthalmology. Unfortunately, reporting on psychometric quality is limited, and content development is most often done without patient involvement.
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Affiliation(s)
- Jarinne E Woudstra-de Jong
- Rotterdam Ophthalmic Institute, Eye Hospital Rotterdam, Rotterdam, the Netherlands; Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, the Netherlands.
| | - Sonia S Manning-Charalampidou
- Rotterdam Ophthalmic Institute, Eye Hospital Rotterdam, Rotterdam, the Netherlands; Department of Vitreoretinal Surgery, Eye Hospital Rotterdam, Rotterdam, the Netherlands
| | - Hans Vingerling
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Jan J Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Konrad Pesudovs
- School of Optometry and Vision Science, Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
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Fan H, Qian Z, Tzekov R, Lin D, Wang H, Li W. A New Two-Step Anesthesia for 23- or 25-Gauge Vitrectomy Surgery: A Prospective, Randomized Clinical Trial. Ophthalmic Res 2020; 64:34-42. [PMID: 32388512 DOI: 10.1159/000508510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/08/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of topical anesthesia combined with subconjunctival anesthesia (termed two-step anesthesia) for 23- or 25-gauge pars plana vitrectomy or other posterior segment surgery. METHODS Patients (n = 90) requiring 23-/25-gauge vitrectomy or other posterior segment surgery were randomized into 3 groups. Group 1 received peribulbar anesthesia, group 2 received retrobulbar anesthesia and group 3 received two-step anesthesia. A 5-point visual analog pain scale (VAPS) was used to measure self-report of patient pain. Complications were recorded for subsequent analysis. RESULTS VAPS scores for overall intraoperative pain ranged from 0 to 3 (1.07 ± 1.07) in group 1, from 0 to 2 (0.69 ± 0.93) in group 2 and from 0 to 3 (1.06 ± 0.98) in group 3. Assessment of surgeon discomfort score ranged from 0 to 2 (0.31 ± 0.66) in group 1, from 0 to 3 (0.38 ± 0.82) in group 2 and from 0 to 2 (0.47 ± 0.62) in group 3. Both scores reveal no significant difference among the 3 groups. While there were no complications noted in group 1, there was an ocular perforation in group 2. Additionally, there were no complications in group 3 related to the anesthetic technique. CONCLUSIONS Results suggest that two-step anesthesia is a safe and effective anesthetic approach for selected patients undergoing 23- or 25-gauge pars plana vitrectomy or other posterior segment surgeries. It may offer a viable alternative to peribulbar anesthesia and retrobulbar anesthesia for carefully selected 23- or 25-gauge cannular-access ocular surgeries.
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Affiliation(s)
- Hua Fan
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Zhuyun Qian
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Radouil Tzekov
- Department of Ophthalmology, University of South Florida, Tampa, Florida, USA
| | - Dong Lin
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Hongxia Wang
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Wensheng Li
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China, .,Aier School of Ophthalmology, Central South University, Changsha, China,
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Sebag J. Vitreous and Vision Degrading Myodesopsia. Prog Retin Eye Res 2020; 79:100847. [PMID: 32151758 DOI: 10.1016/j.preteyeres.2020.100847] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 03/01/2020] [Accepted: 03/03/2020] [Indexed: 12/16/2022]
Abstract
Macromolecules comprise only 2% of vitreous, yet are responsible for its gel state, transparency, and physiologic function(s) within the eye. Myopia and aging alter collagen and hyaluronan association causing concurrent gel liquefaction and fibrous degeneration. The resulting vitreous opacities and collapse of the vitreous body during posterior vitreous detachment are the most common causes for the visual phenomenon of vitreous floaters. Previously considered innocuous, the vitreous opacities that cause floaters sometimes impact vision by profoundly degrading contrast sensitivity function and impairing quality-of-life. While many people adapt to vitreous floaters, clinically significant cases can be diagnosed with Vision Degrading Myodesopsia based upon echographic assessment of vitreous structure and by measuring contrast sensitivity function. Perhaps due to the ubiquity of floaters, the medical profession has to date largely ignored the plight of those with Vision Degrading Myodesopsia. Improved diagnostics will enable better disease staging and more accurate identification of severe cases that merit therapy. YAG laser treatments may occasionally be slightly effective, but vitrectomy is currently the definitive cure. Future developments will usher in more informative diagnostic approaches as well as safer and more effective therapeutic strategies. Improved laser treatments, new pharmacotherapies, and possibly non-invasive optical corrections are exciting new approaches to pursue. Ultimately, enhanced understanding of the underlying pathogenesis of Vision Degrading Myodesopsia should result in prevention, the ultimate goal of modern Medicine.
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Affiliation(s)
- J Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, CA, USA; Doheny Eye Institute, Pasadena, CA, USA; Department of Ophthalmology, Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Safety in office-based anesthesia: an updated review of the literature from 2016 to 2019. Curr Opin Anaesthesiol 2020; 32:749-755. [PMID: 31503034 DOI: 10.1097/aco.0000000000000794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Office-based anesthesia (OBA) is rapidly growing across the world. Availability of less invasive interventions has facilitated the opportunity of offering new procedures in office-based settings to patient populations that would not have been considered in the past. This article provides a practical approach to discuss and analyze newest literature supporting different practices in the field of OBA. In addition, an update of the most recent guidelines and practice management directives is included. RECENT FINDINGS Selected procedures may be performed in the office-based scenario with exceedingly low complication rates, when the right patient population is selected, and adequate safety protocols are followed. Current regulations are focused on reducing surgical risk through the implementation of patient safety protocols and practice standardization. Strategies include cognitive aids for emergencies, safety checklists, facility accreditation standards among other. SUMMARY New evidence exists supporting procedures in the office-based scenario in areas such as plastic and cosmetic surgery, dental and oral surgery, ophthalmology, endovascular procedures and otolaryngology. Different systematic approaches have been developed (guidelines and position statements) to promote standardization of safe practices through emergency protocols, safety checklists, medication management and surgical risk reduction. New regulations and accreditation measures have been developed to homogenize practice and promote high safety standards.
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Yannuzzi NA, Sridhar J, Flynn HW, Gayer S, Berrocal AM, Patel NA, Townsend J, Smiddy WE, Albini T. Current Trends in Vitreoretinal Anesthesia. Ophthalmol Retina 2019; 3:804-805. [PMID: 31307941 DOI: 10.1016/j.oret.2019.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Steven Gayer
- Department of Anesthesiology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Justin Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Thomas Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida.
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Kumawat D, Sahay P, Sundar D, Chawla R. Comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting. Indian J Ophthalmol 2018; 67:181-182. [PMID: 30574947 PMCID: PMC6324095 DOI: 10.4103/ijo.ijo_1384_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pranita Sahay
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Dheepak Sundar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Trujillo-Sanchez GP, Rosa AGDL, Navarro-Partida J, Haro-Morlett L, Altamirano-Vallejo JC, Santos A. Response to comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting. Indian J Ophthalmol 2018; 67:182-183. [PMID: 30574949 PMCID: PMC6324093 DOI: 10.4103/ijo.ijo_1516_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gloria P Trujillo-Sanchez
- Centro de Retina Médica y Quirurgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Jalisco, México
| | - Alejandro Gonzalez-De la Rosa
- Centro de Retina Médica y Quirurgica, S.C., Centro Médico Puerta de Hierro; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Jalisco, México
| | - Jose Navarro-Partida
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Jalisco, México
| | - Luis Haro-Morlett
- Centro de Retina Médica y Quirurgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Jalisco, México
| | - Juan C Altamirano-Vallejo
- Centro de Retina Médica y Quirurgica, S.C., Centro Médico Puerta de Hierro; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Jalisco, México
| | - Arturo Santos
- Centro de Retina Médica y Quirurgica, S.C., Centro Médico Puerta de Hierro; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Jalisco, México
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Mohan A, Venkatesh R. Commentary: Office-based vitrectomy using topical anesthesia in an Indian setting. Indian J Ophthalmol 2018; 66:1141-1142. [PMID: 30038159 PMCID: PMC6080464 DOI: 10.4103/ijo.ijo_792_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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