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Kanabar R, Craven W, Wilson H, Rietdyke R, Dhawahir-Scala F, Jinkinson M, Newman WD, Harper RA. Evaluation of the Manchester COVID-19 Urgent Eyecare Service (CUES). Eye (Lond) 2022; 36:850-858. [PMID: 33931762 PMCID: PMC8086227 DOI: 10.1038/s41433-021-01522-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/01/2021] [Accepted: 03/26/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Pressure on capacity in ophthalmology alongside the coronavirus (COVID-19) pandemic led to the development of the COVID-19 Urgent Eyecare Service (CUES), allowing patients to receive a prompt ophthalmic consultation, including remotely. The aim of this study was to conduct a service evaluation of CUES in Manchester. METHODS Data were collected both prospectively and retrospectively from both primary and secondary care over an 8-week period from June to August 2020. RESULTS In primary care CUES in Greater Manchester (GM) 2461 patients were assessed, with a majority self-referring to the service (68.7%, n = 1844). 91.7% of cases initially screened for CUES were deemed eligible and given a telemedicine appointment in GM; 53.3% of these cases required face-to-face consultation. 14.3% of cases seen within in GM CUES (351 out of 2461) were provisionally referred to secondary care. Contemporaneously the main provider emergency eyecare department (EED) attendances were reduced by 37.7% per month between April and December 2020 inclusive, compared to the same months in 2019. Patients attending a CUES face-to-face assessment were more likely to have a diagnosis in agreement with secondary care, compared to patients referred in from telemedicine assessment only (P < 0.05). CONCLUSION This evaluation of CUES demonstrates a high level of primary care activity alongside a sustained reduction in EED cases. The case-mix of patients seen within EED following referral appears to be of a less benign nature than those cases seen prior to the introduction of CUES.
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Affiliation(s)
- Rahul Kanabar
- grid.5379.80000000121662407Manchester Medical School, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Wendy Craven
- Primary Eyecare Service, 2.3 Waulk Mill, 51 Bengal Street, Manchester, M4 6LN UK
| | - Helen Wilson
- grid.498924.a0000 0004 0430 9101Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL UK
| | - Rebecca Rietdyke
- Primary Eyecare Service, 2.3 Waulk Mill, 51 Bengal Street, Manchester, M4 6LN UK
| | - Felipe Dhawahir-Scala
- grid.498924.a0000 0004 0430 9101Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL UK
| | - Matthew Jinkinson
- Primary Eyecare Service, 2.3 Waulk Mill, 51 Bengal Street, Manchester, M4 6LN UK
| | - William D. Newman
- grid.498924.a0000 0004 0430 9101Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL UK
| | - Robert A. Harper
- grid.498924.a0000 0004 0430 9101Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL UK ,grid.5379.80000000121662407Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL UK
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Williams E, Craven W, Wilson H, Dhawahir-Scala F, Jinkinson M, Newman WD, Harper RA. Reassurance on false negatives in the Manchester COVID19 Urgent Eyecare Service (CUES). Eye (Lond) 2022; 36:12-14. [PMID: 34584233 PMCID: PMC8477717 DOI: 10.1038/s41433-021-01774-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/20/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- Emma Williams
- grid.498924.aManchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, UK
| | - Wendy Craven
- Primary Eyecare Service, 2.3 Waulk Mill, Manchester, UK
| | - Helen Wilson
- grid.498924.aManchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, UK
| | - Felipe Dhawahir-Scala
- grid.498924.aManchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, UK
| | - Matthew Jinkinson
- Primary Eyecare Service, 2.3 Waulk Mill, Manchester, UK ,Greater Manchester Eye Health Network, Health & Social Care Partnership, Manchester, UK
| | - William D. Newman
- grid.498924.aManchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, UK
| | - Robert A. Harper
- grid.498924.aManchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, UK ,grid.5379.80000000121662407Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Harper RA, Dhawahir-Scala F, Wilson H, Gunn PJG, Jinkinson M, Pretty IA, Fletcher S, Newman WD. Development and implementation of a Greater Manchester COVID19 Urgent Eyecare Service. Eye (Lond) 2021; 35:705-708. [PMID: 32601500 PMCID: PMC7322717 DOI: 10.1038/s41433-020-1042-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Robert A Harper
- Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL, UK.
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK.
| | - Felipe Dhawahir-Scala
- Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL, UK
| | - Helen Wilson
- Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL, UK
| | - Patrick J G Gunn
- Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL, UK
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
| | - Matthew Jinkinson
- Greater Manchester Eye Health Network, Health & Social Care Partnership, 3 Piccadilly Place, London Road, Manchester, M1 3BN, UK
- Primary Eyecare Service, 2.3 Waulk Mill, 51 Bengal Street, Manchester, M4 6LN, UK
| | - Iain A Pretty
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Sara Fletcher
- Manchester Clinical Commissioning Group, 1st Floor, Parkway 1, Parkway Business Centre, Princess Road, Manchester, M14 7 LU, UK
| | - William D Newman
- Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL, UK
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Ziahosseini K, Newman WD. Challenges of managing sympathetic ophthalmia in a young child and the role of infliximab. J Pediatr Ophthalmol Strabismus 2011; 48 Online:e34-6. [PMID: 21732578 DOI: 10.3928/01913913-20110628-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 06/01/2011] [Indexed: 11/20/2022]
Abstract
The authors report the difficult challenges and use of infliximab in the delayed presentation of a 2½-year-old boy with a penetrating eye injury from a small ballpoint pen that led to sympathetic ophthalmia.
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Affiliation(s)
- Kimia Ziahosseini
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, United Kingdom.
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Brown MC, Southern CL, Anbarasu A, Kaye SB, Fisher AC, Hagan RP, Newman WD. Congenital absence of optic chiasm: demonstration of an uncrossed visual pathway using monocular flash visual evoked potentials. Doc Ophthalmol 2006; 113:1-4. [PMID: 16906412 DOI: 10.1007/s10633-006-9005-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Accepted: 05/15/2006] [Indexed: 11/27/2022]
Abstract
A 35 month old child was referred for electrophysiology testing with pendular nystagmus, corresponding head oscillations and reduced vision. Flash visual evoked potential (VEP) revealed large responses at the right occiput (but not the left occiput) from the right eye and similar large responses at only the left occiput from the left eye, indicating absent/deficient crossover at the chiasm. A magnetic resonance imaging (MRI) scan subsequently confirmed absence of the optic chiasm. There was no other evidence of midline brain defects. Her subsequent development to age 11 has been followed. The nystagmus has remained mainly horizontal but a torsional component was noted from age 5 years and described as see-saw at age 6 years. A small right esotropia was noted at 6 years and spectacles prescribed for low hypermetropic refractive error. Bilateral superior rectus recessions at age 7 years produced an improved head posture. Her visual acuity has remained stable at around 6/24 from age 4 years. No binocularity nor stereopsis has been demonstrated over subsequent visits.
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Affiliation(s)
- Malcolm C Brown
- Department of Clinical Engineering, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK.
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Newman WD, Hollman AS, Dutton GN, Carachi R. Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol 2002; 86:1109-13. [PMID: 12234888 PMCID: PMC1771326 DOI: 10.1136/bjo.86.10.1109] [Citation(s) in RCA: 191] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM To evaluate the utility of measuring the optic nerve sheath diameter in children with shunted hydrocephalus, suspected of having raised intracranial pressure. METHODS 23 children with shunted hydrocephalus were examined, six had well controlled ICP, 17 however manifested symptoms suggestive of intracranial hypertension. A clinical history was taken from all patients and their parents or carers. The shunt valve was examined clinically, and signs of raised intracranial pressure were sought. Ultrasound examination was performed in both eyes to measure the optic nerve sheath diameters 3 mm behind the globe. These measurements were compared with control data obtained from 102 children who attended the radiology department for unrelated renal ultrasound examination. RESULTS Control data suggested that the upper limit of normal for optic nerve sheath diameter is 4.5 mm (measured 3 mm behind the globe) in patients over 1 year of age, and 4.0 mm in children less than 1 year of age. Those patients with functioning ventriculoperitoneal shunts had a mean optic nerve sheath diameter of 2.9 (SD 0.5) mm; those with raised intracranial pressure had a mean optic nerve sheath diameter of 5.6 (0.6) mm (p<0.0001). These results confirm that optic nerve sheath diameters in excess of the control data are strongly suggestive of raised intracranial pressure. CONCLUSION The evaluation of the optic nerve sheath diameter is a simple non-invasive procedure, which is a potentially useful tool in the assessment and monitoring of children with hydrocephalus suspected of having raised intracranial pressure.
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Affiliation(s)
- W D Newman
- Department of Ophthalmology, The Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK.
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Newman WD, Tocher K, Acheson JF. Vigabatrin associated visual field loss: a clinical audit to study prevalence, drug history and effects of drug withdrawal. Eye (Lond) 2002; 16:567-71. [PMID: 12194070 DOI: 10.1038/sj.eye.6700168] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To survey clinical visual function including quantitative manual perimetry results in a group of patients taking vigabatrin; to assess the severity of any field defects; to tabulate cumulative and daily doses of medication and to assess possible changes in visual function over time. METHOD A prevalence study of 100 out of 183 patients currently attending a tertiary referral epilepsy centre who were taking or had recently discontinued vigabatrin (duration 83-3570 days; mean 1885 days) as part of combination anticonvulsant therapy. Complete neuro-ophthalmic examination including Goldmann kinetic perimetry was performed and monocular mean radial degrees (MRD) to the I/4e isopter calculated. Patients were followed up at 6-monthly intervals for not less than 18 months. RESULTS Acuity and colour vision remained stable in all patients regardless of changes in visual fields. Twenty per cent of patients had significant constriction of their visual field defined as a monocular MRD of 30 degrees or less. Males were significantly more likely to be severely affected than females (P < 0.01). Twenty one patients were followed after discontinuing vigabatrin treatment. Only three of these showed a change in MRD of 10 degrees or more with two deteriorating and one improving. No correlation between treatment duration or cumulative dosage/kg and the severity of defects could be demonstrated. CONCLUSIONS Earlier reports of a high prevalence of both moderate and more serious field defects were confirmed in patients taking vigabatrin but not in epileptic patients taking other anti-convulsants. We found no evidence of progression or resolution of visual field defects on discontinuing the drug, and no relationship between dose history and visual deficit field loss. An idiosyncratic drug reaction within the neurosensory retina may underlie the pathogenesis of the visual field loss in some patients.
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Affiliation(s)
- W D Newman
- Dept of Neuro-ophthalmology, National Hospital for Neurology & Neurosurgery, Queen Square, London WC1N 3BG, UK
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Newman WD, Dorrell ED. Anterior ischemic optic neuropathy associated with disc drusen. J Neuroophthalmol 1996; 16:7-8. [PMID: 8963424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Anterior ischemic optic neuropathy (AION) is a condition more commonly found in later life. We present a case of unilateral AION in a 13-year-old boy with small discs and ipsilateral optic nerve head drusen.
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Affiliation(s)
- W D Newman
- Westbourne Eye Hospital, Bournemouth, Dorset, England
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Abstract
Pyoderma gangrenosum is an uncommon chronic ulcerative condition, the aetiology of which is poorly understood. Ophthalmic involvement is rare. The case presented in this paper involves destruction of the orbital contents with subsequent perforation of the eye despite conventional therapy. Evisceration was performed with the patient being subjected to hyperbaric oxygen therapy pre- and post-operatively, with resultant cessation of the disease process.
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Affiliation(s)
- W D Newman
- Royal Victoria Hospital, Westbourne, Bournemouth, UK
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