Validity of EuroQOL-5D, time trade-off, and standard gamble for age-related macular degeneration in the Singapore population.

BACKGROUND/AIMS: Utility values of age-related macular degeneration (AMD) in Asian patients are unknown. This study aims to assess utility values and construct validity of the EuroQOL-5D (EQ-5D), time trade-off (TTO), and standard gamble (SG) instruments in the Singapore multi-ethnic AMD population. METHODS: Cross-sectional, two-centre, institution-based study. Visual acuity (VA), clinical AMD severity, and utility scores on the EQ-5D, TTO, and SG were obtained from 338 AMD patients. VA was analysed in terms of the better-seeing eye (BEVA), worse-seeing eye (WEVA), and weighted average of both eyes (WVA). We evaluated SG on the perfect health-death (SG(death)) and binocular perfect vision-binocular blindness (SG(blindness)) scales. Construct validity was determined by testing a priorihypotheses relating the EQ-5D, TTO, and SG utility scores to VA and clinical AMD severity. RESULTS: The mean utilities on the EQ-5D, TTO, SG(death), and SG(blindness) were 0.89, 0.81, 0.86, and 0.90, respectively. EQ-5D scores correlated weakly with BEVA, WEVA, and WVA (Pearson's correlation coefficients -0.291, -0.247, and -0.305 respectively, P<0.001 for all). SG(death) and SG(blindness) demonstrated no correlation with BEVA, WEVA, or WVA (Pearson's correlation coefficients, range -0.06 to -0.125). TTO showed weak association only with WEVA and WVA (correlation coefficients -0.237, -0.228, P<0.0001), but not with BEVA (correlation coefficient -0.161). Clinical AMD severity correlated with EQ-5D and SG(death), but not with TTO and SG(blindness) (P=0.004, 0.002, 0.235, and 0.069, respectively). CONCLUSIONS: AMD has a negative impact on utilities, although utility scores were high compared with Western cohorts. EQ-5D, TTO, and SG showed suboptimal construct validity, suggesting that health status utilities may not be sufficiently robust for cost-utility analyses in this population.

Awareness of blindness and other smoking-related diseases and its impact on motivation for smoking cessation in eye patients.

PURPOSE: Cigarette smoking is a major cause of morbidity and mortality. The association between smoking and eye diseases is less widely recognised relative to other better-known smoking-related conditions. This study aims to assess the awareness and fear of known smoking-related diseases among current smokers attending an ophthalmology outpatient clinic and to evaluate their relative impact on the likelihood of smoking cessation. PATIENTS AND METHODS: A cross-sectional survey using a structured interview of randomly selected current smokers attending an eye clinic was conducted. The knowledge of six smoking-related diseases (lung cancer, heart attack, stroke, blindness, other cancers, and other lung diseases) was assessed. The fear of smoking-related conditions and the relative impact of each smoking-related condition on the smoker's motivation to quit smoking were evaluated. RESULTS: Out of 200 current smokers aged from 14 to 83 years, only 42.5% (85 patients) were aware that smoking causes blindness. Smokers' perception of harm caused by smoking was 6.53±3.21 (mean±SD) on a visual analogue scale of 0 to 10. Patients placed blindness as the second most important motivating factor to quit smoking immediately, within 1 year and 5 years, after lung cancer. CONCLUSION: The awareness of the risk of blindness from smoking was lowest compared with five other smoking-related diseases among eye patients who smoke. However, blindness remains a key motivational factor in smoking cessation and hence should be emphasised as an important negative health consequence of smoking in public health education and anti-smoking campaigns.

Optic neuropathy associated with dengue fever.

PURPOSE: To report a case series of three patients of optic neuropathy associated with dengue fever. METHODS: Observational case series. RESULTS: Three patients aged of 19, 31, and 40 years (cases 1, 2, and 3) complained of unilateral blurring of vision within a week of being diagnosed with dengue fever. Their presenting visual acuities were counting fingers in cases 1 and 2, and 6/6 in case 3, with features suggestive of optic neuropathy. Two of the three patients (cases 2 and 3) had bilateral ocular signs. The visual acuity recovered to 6/9 in case 1, worsened to no light perception in case 2, and remained unchanged in case 3. CONCLUSIONS: Although spontaneous visual recovery is possible, optic neuropathy associated with dengue fever may result in severe and permanent visual loss.

Practice preferences of ophthalmic anaesthesia for cataract surgery in Singapore.

INTRODUCTION: This study aims to describe the preferences of ophthalmic anaesthesia for cataract extraction among ophthalmologists in Singapore. METHODS: A nationwide questionnaire survey of all cataract surgeons in institutional and private practice in Singapore was conducted in August 2004. RESULTS: The response rate was 61.1 percent (88 out of 144 eligible ophthalmologists surveyed). Phacoemulsification was the preferred surgical technique for 92 percent of the respondents while extra-capsular cataract extraction was preferred by eight percent. For all surgeons performing phacoemulsification, the anaesthesia technique of choice was peribulbar anaesthesia for 43 percent, topical anaesthesia for 42 percent, retrobulbar anaesthesia for 13 percent, and sub-tenons and general anaesthesia for one percent each of the respondents. For all the surgeons performing extra-capsular cataract extraction, the preferred anaesthetic technique was peribulbar anaesthesia for 69 percent, retrobulbar anaesthesia for 30 percent and sub-tenons anaesthesia for one percent of the respondents. The surgeons' main reasons for choosing a specific anaesthesia modality for their surgery were patient comfort and surgeon's choice. The majority of surgeons used mild sedation and monitored anaesthesia care for their cataract surgeries. CONCLUSION: Peribulbar anaesthesia is currently the preferred anaesthesia technique for both phacoemulsification and extra-capsular cataract extraction in Singapore. Topical anaesthesia closely follows peribulbar anaesthesia as a preferred choice for phacoemulsification.