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PURPOSE OF REVIEW: Advanced keratectasia often requires corneal transplantation for restoration of vision. This review discusses the surgical approach suitable for these cases including significant updates in the current literature. RECENT FINDINGS: With greater understanding of ectatic corneal disease and its associated operative challenges, several modifications in the surgical approach have been developed. Identified predictive factors for successful pneumatic dissection and intraoperative complications have informed surgical planning and decision-making. In the setting of failed pneumatic dissection, sequential use of alternative lamellar dissection techniques is a reasonable surgical strategy. Surgical refinements to optimize visual outcomes and postoperative interventions to correct residual refractive errors have improved visual rehabilitation after keratoplasty. SUMMARY: With evidence of its undisputed advantages, DALK has been widely recognized as the primary surgical option for ectatic corneal disease.
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Transplante de Córnea/métodos , Ceratocone/cirurgia , Dilatação Patológica/cirurgia , Humanos , Complicações Intraoperatórias , Erros de Refração/reabilitação , Procedimentos Cirúrgicos Refrativos , Resultado do TratamentoRESUMO
Phakic intraocular lenses (pIOL) are recommended when counselling refractive surgery candidates presenting with high ametropia or ocular surface and/or corneal conditions that contraindicate corneal refractive surgery. This review aims to present the state-of-the-art regarding pIOL models currently available in Europe, addressing their newer indications and recent design innovations. These include, in the case of posterior chamber pIOLs, the addition of a central hole to improve aqueous humour circulation, the availability of larger optical zones, and multifocal optics for the compensation of presbyopia. The review also highlights their good safety and efficacy results, as well as the role of patient education to ensure adequate outcomes in the medium-long term. The indications of pIOLs in special situations, as well as bi-lensectomy, a procedure that most pIOL patients may eventually require as they age and develop cataracts, are also addressed.
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Lentes Intraoculares Fácicas/tendências , Desenho de Prótese , Erros de Refração/reabilitação , Europa (Continente) , Humanos , Implante de Lente Intraocular/métodos , Lentes Intraoculares Multifocais , Educação de Pacientes como Assunto , Lentes Intraoculares Fácicas/provisão & distribuição , Presbiopia/reabilitação , SegurançaRESUMO
PURPOSE: To explore socioeconomic inequality in global burden of refraction disorders using disability-adjusted life years (DALYs). METHODS: World Bank categorical and national DALY numbers, crude rates and age-standardized rates caused by refraction disorders between 1990 and 2017 were obtained. Gini coefficient and concentration index were computed to assess trends in global health inequality in refraction disorders burden. RESULTS: Lower middle-income countries had the highest burden of refraction disorders and greatest decline in age-standardized DALY rates of 15.9% (171.0 in 1990; 143.8 in 2017), followed by upper middle-income countries, with a 9.7% decline (103.7 in 1990; 93.7 in 2017). High-income countries had the lowest age-standardized DALY rates (70.4 in 1990; 65.7 in 2017), while low-income countries had the lowest DALY numbers. Between-country inequality decreased, with Gini coefficient declining from 0.203 in 1990 to 0.184 in 2017. Socioeconomic-associated inequality also decreased, with concentration index changing from -0.060 in 1990 to -0.041 in 2017. Small peaks of DALY numbers and crude rates occurred in the age group of 5-9 years in countries with different income levels. An earlier occurrence of high peaks of DALY estimates in older adults had been observed in countries with lower income. CONCLUSION: Middle-income countries are more burdened with refraction disorders but have achieved great progress in the last few decades. The global health improvement in refraction disorders has been accompanied by narrowing inequality. Older adults in lower income countries tend to suffer from refraction disorders at an earlier age, compared with older adults in higher income countries.
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Efeitos Psicossociais da Doença , Pessoas com Deficiência/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Erros de Refração/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Anos de Vida Ajustados por Qualidade de Vida , Erros de Refração/epidemiologia , Erros de Refração/reabilitação , Distribuição por Sexo , Fatores Socioeconômicos , Adulto JovemRESUMO
PURPOSE: To compare the effects of bifocal versus trifocal diffractive intraocular lens (IOL) implantation on visual quality after phacoemulsification in patients with cataracts. METHODS: Eighty-eight eyes from 63 patients were analyzed. Trifocal (AT LISA tri 839MP), bifocal (AcrySof IQ ReSTOR) and bifocal (Tecnis MF ZLB00) IOLs were implanted into 53, 18, and 17 eyes, respectively. Uncorrected distance, intermediate and near visual acuity, refractive errors, contrast sensitivity, and patient satisfaction were measured at 1 week and 1 month after surgery. Refractive error was converted to a spherical equivalent and compared to predicted refraction calculated by IOL calculation formulas. RESULTS: Uncorrected distance, intermediate, and near visual acuity did not differ significantly between groups. One month after surgery, the mean refractive errors were -0.07 diopters (D) in the AT LISA tri 839MP group, +0.18 D in the AcrySof IQ ReSTOR group, and +0.31 D in the Tecnis MF ZLB00 group (p < 0.001). The predictive accuracy of IOL calculation formulas did not differ between groups. Contrast sensitivity, satisfaction, and spectacle independence in the trifocal group were comparable with those of the two bifocal groups. CONCLUSIONS: Trifocal IOL and two different types of bifocal IOL implantation were all effective for improving visual quality, although refractive error in patients with trifocal IOL shows myopic tendencies.
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Extração de Catarata , Lentes Intraoculares Multifocais , Refração Ocular/fisiologia , Erros de Refração/reabilitação , Acuidade Visual/fisiologia , Biometria , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Período Pós-Operatório , Desenho de Prótese , Erros de Refração/fisiopatologia , Estudos RetrospectivosRESUMO
Purpose: Uncorrected refractive errors are the leading cause of visual impairment in children, affecting children in all settings. The majority of refractive errors can be corrected with spectacles. High compliance with spectacle wear is required for children to realize the benefit, such as higher academic achievement. This review collates evidence on compliance with spectacle wear, factors which predict spectacle wear and reasons for non-compliance among schoolchildren.Methods: Literature searches were conducted on Medline, Embase, Global Health and the Cochrane Library. The date range was January 2000 to November 2017 and there were no language restrictions. The search retrieved a total of 1299 references, 522 duplicate records were removed leaving 777 references to assess. Twenty-five studies were included in the review.Results: Evidence suggests that greater severity of uncorrected refractive error and lower levels of uncorrected visual acuity are associated with higher levels of spectacle wear. Addressing socio-demographic reasons for non-compliance is complex as they are context specific. Evidence that children become less compliant with spectacle wear with increasing age is not consistent. Quantitative data indicate girls are more likely to be compliant with spectacles wear than boys, but qualitative studies highlight specific challenges faced by girls.Conclusion: There was considerable variation between studies in how spectacle compliance was defined, the time interval between dispensing the spectacles and assessment, and how compliance was assessed. There is need to standardize all aspects of the assessment of compliance. Further qualitative and quantitative studies are required in a range of settings to assess the biomedical and socio-demographic factors which affect spectacle wear compliance using standard definitions.
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Óculos , Cooperação do Paciente , Erros de Refração/reabilitação , Criança , Humanos , Fatores SocioeconômicosRESUMO
SIGNIFICANCE: Our study suggests that patients would benefit from adjusting their distance spectacles several years after cataract surgery. This may lead to a better quality of life for these patients. PURPOSE: The purpose of this study was to determine whether patients' distance vision is optimally corrected with spectacles 6 to 7 years after cataract surgery and whether patients with glaucoma who regularly visit an ophthalmologist have more correct power in their spectacles. METHODS: A total of 153 patients (153 eyes) who underwent cataract surgery with phacoemulsification at Oslo University Hospital were examined 6 to 7 years after surgery. Patients with better or equal best-corrected distance visual acuity in the study eye compared with the other eye were included (n = 90; 59%). Vision-related outcomes were measured and analyzed, including a modified version of the visual function questionnaire, Visual Function-14 (VF-14). RESULTS: A significant difference was found in the logMAR score between the patients' habitual correction (if any) and those with best-corrected distance visual acuity measured at the postoperative study examination (0.20 ± 0.40 and 0.10 ± 0.39, respectively; P < .0001). Patients with glaucoma (n = 17) did not have more correct power of their spectacles than did patients without glaucoma (n = 73; P = .38). The overall mean VF-14 score was 89%, with a statistically significant correlation between a high VF-14 score and a good habitual distance correction (r = -0.82; P < .0001). CONCLUSIONS: This study indicates that, although the patients are quite satisfied with their visual function 6 to 7 years after cataract surgery, many patients are not making the most of their visual potential. Thus, there seems to be a need for better monitoring of patients' distance refraction and spectacle use for an extended period after cataract surgery.
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Óculos/estatística & dados numéricos , Implante de Lente Intraocular , Facoemulsificação , Erros de Refração/reabilitação , Acuidade Visual/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pseudofacia/fisiopatologia , Qualidade de Vida , Erros de Refração/fisiopatologia , Inquéritos e Questionários , Fatores de TempoRESUMO
PURPOSE: To survey a large number of UK-based optometrists, in a variety of settings, to determine current attitudes relating to the use of cycloplegia and spectacle prescribing in children aged ≤11 years. METHODS: One thousand randomly selected members of the College of Optometrists (UK) were invited to complete an electronic questionnaire. The questionnaire was comprised of 42 questions relating to respondent demographics, practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children aged ≤11 years. RESULTS: Three hundred and eleven practitioners (31%) completed the questionnaire. Practitioners agreed that they are confident carrying out cycloplegic refraction (60%) and instilling cyclopentolate (77%); are not concerned about the time the procedure takes (69%); feel parents are receptive to its use (65%) and are not discouraged by side effects (72%). Most practitioners agreed that they would carry out a cycloplegic refraction in pre-school children (aged 2-4 years) at their first eye exam (34% vs 27%), but would not carry out a cycloplegic refraction in a child of school age (5-7 years: 25% vs 47%, 8-11 years: 12% vs 45%). More recently qualified practitioners are more likely to be proactive in using cycloplegia (Mann-Whitney, p = 0.003). Community practitioners prescribed at slightly lower levels of ametropia in non-strabismic children than those working in a hospital setting both in the present study and in comparison to previously published hospital optometry values, particularly for hyperopia at 1 year of age. CONCLUSIONS: This is the first study to report practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children in a large number of UK-based optometrists practising in a variety of settings. The majority of practitioners responded in a positive manner to the use of cycloplegia and reported patterns of use which adhere closely to available professional guidance. However, outcomes indicate practitioners may appreciate more comprehensive evidence-based resources to inform their decision-making relating to use of cycloplegia in paediatric examination.
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Ciclopentolato/administração & dosagem , Óculos/estatística & dados numéricos , Midriáticos/administração & dosagem , Optometria/métodos , Padrões de Prática Médica/estatística & dados numéricos , Erros de Refração , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Prescrições/estatística & dados numéricos , Erros de Refração/diagnóstico , Erros de Refração/reabilitação , Reino UnidoRESUMO
Importance: Visual impairment from uncorrected refractive errors affects 12.8 million children globally. Spectacle correction is simple and cost-effective; however, low adherence to spectacle wear, which can occur in all income settings, limits visual potential. Objective: To investigate predictors of spectacle wear and reasons for nonwear in students randomized to ready-made or custom-made spectacles. Design, Setting, and Participants: In planned secondary objectives of a noninferiority randomized clinical trial, students aged 11 to 15 years who fulfilled eligibility criteria, which included improvement in vision with correction by at least 2 lines in the better eye, were recruited from government schools in Bangalore, India. Recruitment took place between January 12 and July 15, 2015, and analysis for the primary outcome occurred in August 2016. Data analysis for the secondary outcome was conducted in August 2018. Spectacle wear was assessed by masked observers at unannounced visits to schools 3 to 4 months after spectacles were distributed. Students not wearing their spectacles were asked an open-ended question to elicit reasons for nonwear. Main Outcomes and Measures: Predictors of spectacle wear and reasons for nonwear. Results: Of 460 students recruited and randomized (52.2% male; 46 students aged 11 to 12 years and 13 to 15 years in each trial arm), 78.7% (362 of 460) were traced at follow-up, and 25.4% (92 of 362) were not wearing their spectacles (no difference between trial arms). Poorer presenting visual acuity (VA) and improvement in VA with correction predicted spectacle wear. Students initially seen with an uncorrected VA less than 6/18 in the better eye were almost 3 times more likely to be wearing their spectacles than those with less than 6/9 to 6/12 (adjusted odds ratio, 2.84; 95% CI, 1.52-5.27). Improvement of VA with correction of 3 to 6 lines or more than 6 lines had adjusted odds ratios of 2.31 (95% CI, 1.19-4.50) and 2.57 (95% CI, 1.32-5.01), respectively, compared with an improvement of less than 3 lines. The main reason students gave for nonwear was teasing or bullying by peers (48.9% [45 of 92]). Girls reported parental disapproval as a reason more frequently than boys (difference, 7.2%). Conclusions and Relevance: Three-quarters of students receiving spectacles were wearing them at follow-up, which supports the use of the prescribing guidelines applied in this trial. Predictors of spectacle wear, poorer presenting VA, and greater improvement in VA with correction are similar to other studies. Interventions to reduce teasing and bullying are required, and health education of parents is particularly needed for girls in this setting. Trial Registration: isrctn.org Identifier: ISRCTN14715120.
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Óculos/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Erros de Refração/reabilitação , Estudantes/estatística & dados numéricos , Adolescente , Criança , Desenho de Equipamento , Feminino , Humanos , Índia , MasculinoRESUMO
PURPOSE: To investigate the effects of partial and full correction of refractive errors on sensorial and motor outcomes in children with refractive accommodative esotropia (RAE). METHODS: The records of pediatric cases with full RAE were reviewed; their first and last sensorial and motor findings were evaluated in two groups, classified as partial (Group 1) and full correction (Group 2) of refractive errors. RESULTS: The mean age at first admission was 5.84 ± 3.62 years in Group 1 (n = 35) and 6.35 ± 3.26 years in Group 2 (n = 46) (p = 0.335). Mean change in best corrected visual acuity (BCVA) was 0.24 ± 0.17 logarithm of the minimum angle of resolution (logMAR) in Group 1 and 0.13 ± 0.16 logMAR in Group 2 (p = 0.001). Duration of deviation, baseline refraction and amount of reduced refraction showed significant effects on change in BCVA (p < 0.05). Significant correlation was determined between binocular vision (BOV), duration of deviation and uncorrected baseline amount of deviation (p < 0.05). The baseline BOV rates were significantly high in fully corrected Group 2, and also were found to have increased in Group 1 (p < 0.05). Change in refraction was - 0.09 ± 1.08 and + 0.35 ± 0.76 diopters in Groups 1 and 2, respectively (p = 0.005). Duration of deviation, baseline refraction and the amount of reduced refraction had significant effects on change in refraction (p < 0.05). Change in deviation without refractive correction was - 0.74 ± 7.22 prism diopters in Group 1 and - 3.24 ± 10.41 prism diopters in Group 2 (p = 0.472). Duration of follow-up and uncorrected baseline deviation showed significant effects on change in deviation (p < 0.05). CONCLUSIONS: Although the BOV rates and BCVA were initially high in fully corrected patients, they finally improved significantly in both the fully and partially corrected patients. Full hypermetropic correction may also cause an increase in the refractive error with a possible negative effect on emmetropization. The negative effect of the duration of deviation on BOV and BCVA demonstrates the significance of early treatment in RAE cases.
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Acomodação Ocular/fisiologia , Esotropia/fisiopatologia , Óculos , Erros de Refração/reabilitação , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Refração Ocular/fisiologia , Erros de Refração/fisiopatologia , Visão Binocular/fisiologia , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To assess the potential of ready-made (spherical) spectacles (RMS) in meeting the need for refractive correction in visually impaired children in China. METHODS: Eligible children aged 5-17 years were identified from the three study sites in China. Distance visual acuity was measured with a retroilluminated logarithm of the minimum angle of resolution chart with tumbling E optotypes. Cycloplegic autorefraction was performed on all children using a handheld autorefractor. If uncorrected visual acuity (UCVA) was ≤20/40 in either eye, best corrected visual acuity was measured with subjective refractive error. RESULTS : A total of 13 702 children were enumerated from the three studies, with 12 334 (90.0%) having both reliable visual acuity measurements and successful cycloplegia. Among the 12 334 study children, the prevalence of UCVA ≤20/40 in the better seeing eye was 16.4% (95% CI 15.0% to 17.8%), with 91.1% (1843) of these improving by ≥3 lines of visual acuity with refractive correction. Prevalence was 12.7% (95% CI 11.5% to 13.9%) for UCVA <20/50 with 97.4% (1521) improving by ≥3 lines, and 9.38% (95% CI 8.39% to 19.4%) for UCVA ≤20/63 with 98.4% (1138) improving by ≥3 lines. Depending on the severity of visual impairment, 62.8%-64.0% of children could be accommodated with RMS if not correcting for astigmatism of ≤0.75 dioptres and anisometropia of ≤0.50 spherical equivalent dioptres. Approximately 87% of children could be accommodated with RMS if astigmatism and anisometropia limits were increased to ≤1.25 and ≤1.50 dioptres, respectively. CONCLUSIONS: RMS could substantially alleviate visual morbidity in two-thirds or more of visually impaired schoolchildren in China. This cost-effective approach to refractive correction might also be useful in low/middle-income countries with poor access to optometric services.
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Óculos , Erros de Refração/reabilitação , Adolescente , Criança , Pré-Escolar , China/epidemiologia , Estudos Transversais , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Prevalência , Erros de Refração/epidemiologiaRESUMO
BACKGROUND: This study investigates the utility of a temperature sensor data logger to monitor spectacle compliance for future application in research and clinical settings. Specifically, the question of whether warm versus cold climates negatively impact accuracy of the sensor to monitor spectacle wear is investigated. METHODS: Fifty adults from Houston, Texas (summer) and 40 adults from Columbus, Ohio (winter) wore a thermosensor on their spectacles for one week while keeping wear-time logs. Temperatures during reported spectacle wear (ON) were compared to temperatures during non-wear (OFF) between sites. Two methods to approximate wear time were evaluated by percent error with respect to subject-reported wear time. Method 1 filtered temperatures, classifying the range of 28.4 to 35.2°C as wear. Method 2 utilised examiners interpreting temperature versus time plots. Separate analysis of periods of reported outdoor wear was performed to identify the percentage of time examiners correctly identified wear. RESULTS: Group mean ON temperatures did not differ between sites (p = 0.72), but group mean OFF temperatures were significantly warmer in Houston (Houston: 24.7 ± 2.0°C, Columbus: 20.3 ± 2.1°C; p < 0.0001). Median percent error of the filtering technique to approximate subject reported wear time was 4 per cent for Houston and -8 per cent for Columbus. Median percent error for examiner 1: Houston 1 per cent, Columbus 0 per cent; median percent error for examiner 2: Houston 3 per cent, Columbus 0 per cent. Houston outdoor wear was correctly identified 88 and 97 per cent of the time by the examiners versus 79 and 81 per cent for Columbus. CONCLUSION: Despite environmental temperature differences, measured temperatures during spectacle wear were similar across subjects and median percent error was less than 10 per cent for both wear time approximation methods. The device studied was effective for objectively monitoring spectacle wear in both warm and cold climates with the caveat that subjects spent the majority of time indoors.
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Clima Frio , Óculos/estatística & dados numéricos , Monitorização Fisiológica/instrumentação , Erros de Refração/reabilitação , Temperatura , Termometria/instrumentação , Adulto , Desenho de Equipamento , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Termometria/estatística & dados numéricosRESUMO
PURPOSE: The effectiveness of school eye health programmes relies on many factors, including compliance with spectacle wear. The objectives of this study were to determine spectacle compliance in a school vision screening pilot programme in Botswana, and investigate factors predictive of compliance. METHODS: The study was an observational, cross-sectional follow-up of a pilot school screening programme. Unannounced compliance checks were completed after 3-4 months in a convenience sample of 19 schools. Sex, age, school level, visual acuity, and refractive error were analysed using logistic regression to investigate factors predictive of compliance. FINDINGS: Compliance data were recorded for 193/286 (67.5%) children; 62.2% were female and the median age was 15 years (interquartile range 12-17 years). 60.1% of the sample were compliant with spectacle wear. Girls were more likely to be compliant than boys (adjusted odds ratio (aOR) = 2.32, 95% confidence interval (CI) 1.03-5.27). Children at primary and junior secondary school were more likely to be complaint than senior secondary school children (aOR = 16.96, 95% CI 5.60-51.39; and aOR = 3.39, 95% CI 1.39-8.22, respectively). Children with binocular uncorrected visual acuity (UCVA) of 6/7.5 to 6/12 were 2.76 (95% CI1.05-7.23) times more likely to be compliant than children with binocular UCVA of 6/6. CONCLUSION: Compliance was higher in Botswana than previous African studies; however, improvement in this area would increase the effectiveness of the programme. Further investigation into barriers to spectacle wear affecting boys and older children is warranted. A prescribing protocol to avoid low prescriptions - especially where binocular UCVA is 6/6 - is desirable.
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Óculos/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Erros de Refração/reabilitação , Serviços de Saúde Escolar/estatística & dados numéricos , Seleção Visual , Adolescente , Botsuana , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Projetos Piloto , Erros de Refração/diagnóstico , Acuidade VisualRESUMO
Contact lenses have been a common means of vision correction for more than half a century. Recent developments have raised the possibility that the next few decades will see a considerable broadening of the range of applications for contact lenses, with associated expansions in the number and type of individuals who consider them a valuable option. The novel applications of contact lenses include treatment platforms for myopic progression, biosensors, and ocular drug delivery. Orthokeratology has shown the most consistent treatment for myopia control with the least side effects. Recent work has resulted in commercialization of a device to monitor intraocular pressure for up to 24 hours, and extensive efforts are underway to develop a contact lens sensor capable of continuous glucose tear film monitoring for the management of diabetes. Other studies on drug-eluting contact lenses have focused on increasing the release duration through molecular imprinting, use of vitamin E, and increased drug binding to polymers by sandwiching a poly (lactic-co-glycolic acid) layer in the lens. This review demonstrates the potential for contact lenses to provide novel opportunities for refractive management, diagnosis, and management of diseases.
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Técnicas Biossensoriais/métodos , Lentes de Contato , Sistemas de Liberação de Medicamentos/instrumentação , Procedimentos Ortoceratológicos/instrumentação , Diabetes Mellitus/diagnóstico , Glucose/análise , Humanos , Monitorização Fisiológica/métodos , Hipertensão Ocular/diagnóstico , Erros de Refração/reabilitação , Lágrimas/metabolismoRESUMO
PURPOSE: The aims of the study were to assess the magnitude and predictors of the unmet need for spectacles utilization and to quantify its impact on health-related quality of life (HRQOL) among rural Chinese adolescents. METHODS: This school-based survey of 2346 grade-7 students (mean age: 13.8 years) was conducted in Southwestern China in 2016. Spectacles need was defined as uncorrected visual acuity (VA) of 20/40 or worse but correctable to 20/40 or better in the better-seeing eye, together with the presence of myopia of less than -0.5 diopters (D), hyperopia of more than +2.0 D, or astigmatism of more than 0.75 D in both eyes. The HRQOL was measured using self-reported versions of 23-item Pediatric Quality of Life Inventory Version 4.0 Generic Core Scales (PedsQL 4.0). RESULTS: Among 579 (24.7%) adolescents with an uncorrected VA of 20/40 or less, 483 (83.4%) needed vision corrections and 172 (35.6%) used them. Higher parental education levels (odds ratio (OR) = 2.73; 95% CI, 1.29-5.77), negative attitude regarding spectacles (OR = 0.49; 95% CI, 0.25-0.97), and poorer uncorrected VA (OR = 31.27; 95% CI, 3.76-260.23) were independent determinants for spectacles utilization. Adolescents not using spectacles had a lower HRQOL score compared to those using spectacles in terms of psychosocial health (65.91 vs. 70.59; P = 0.028), emotional health (56.85 vs. 63.24; P = 0.012), and social functioning (72.99 vs. 78.60; P = 0.036). CONCLUSIONS: The rate of spectacles utilization in rural China was low. Adolescents were not accustomed to use spectacles had a worse HRQOL score.
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Óculos/estatística & dados numéricos , Qualidade de Vida , Erros de Refração/psicologia , Erros de Refração/reabilitação , População Rural/estatística & dados numéricos , Adolescente , China/epidemiologia , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Miopia/reabilitação , Prevalência , Erros de Refração/epidemiologia , Acuidade VisualRESUMO
OBJECTIVES: To determine the impact of adherence to spectacle wear on visual acuity (VA) and developing literacy following vision screening at age 4-5 years. DESIGN: Longitudinal study nested within the Born in Bradford birth cohort. SETTING AND PARTICIPANTS: Observation of 944 children: 432 had failed vision screening and were referred (treatment group) and 512 randomly selected (comparison group) who had passed (<0.20 logarithm of the minimum angle of resolution (logMAR) in both eyes). Spectacle wear was observed in school for 2 years following screening and classified as adherent (wearing spectacles at each assessment) or non-adherent. MAIN OUTCOME MEASURES: Annual measures of VA using a crowded logMAR test. Literacy was measured by Woodcock Reading Mastery Tests-Revised subtest: letter identification. RESULTS: The VA of all children improved with increasing age, -0.009 log units per month (95% CI -0.011 to -0.007) (worse eye). The VA of the adherent group improved significantly more than the comparison group, by an additional -0.008 log units per month (95% CI -0.009 to -0.007) (worse eye) and -0.004 log units per month (95% CI -0.005 to -0.003) in the better eye.Literacy was associated with the VA, letter identification (ID) reduced by -0.9 (95% CI -1.15 to -0.64) for every one line (0.10 logMAR) fall in VA (better eye). This association remained after adjustment for socioeconomic and demographic factors (-0.33, 95% CI -0.54 to -0.12). The adherent group consistently demonstrated higher letter-ID scores compared with the non-adherent group, with the greatest effect size (0.11) in year 3. CONCLUSIONS: Early literacy is associated with the level of VA; children who adhere to spectacle wear improve their VA and also have the potential to improve literacy. Our results suggest failure to adhere to spectacle wear has implications for the child's vision and education.
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Óculos , Alfabetização/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Erros de Refração/reabilitação , Seleção Visual/métodos , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Refração Ocular , Erros de Refração/fisiopatologia , Instituições Acadêmicas , Reino Unido , Acuidade VisualRESUMO
Purpose: The aim of this study is to survey the management approach, regarding spectacle prescription in children, among Indian ophthalmologists. Methods: A web-based, anonymous questionnaire (multiple choice questions dealing with practical aspects of pediatric refraction), was sent to available database of Indian ophthalmologists. The survey responses (depicted in %) were compared using the amount of pediatric clientele in one's practice (Group A: <25%, Group B: 25% or more). The responses were also analyzed in relation to the published concepts from literature. Results: Two hundred and ten ophthalmologists (2.74% response rate; 48% in Group A), from all over India, responded to the survey. There were wide discrepancies in the responses (both, in and among, Groups A and B; P > 0.05, Chi-square test), as to when and how much refractive error to prescribe in children, for a given situation. Conclusion: A wide gap exists between pediatric spectacle prescription patterns of Indian ophthalmologists, as compared to the recommended pediatric ophthalmology protocols. The management approach, for certain situations concerning the pediatric refraction, was better among those with higher pediatric clientele.
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Óculos/estatística & dados numéricos , Oftalmologistas/normas , Prescrições/estatística & dados numéricos , Erros de Refração/reabilitação , Criança , Estudos Transversais , Feminino , Humanos , Índia , Masculino , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
PURPOSE: To explore the relationship between acquisition of new spectacles after routine cataract surgery and vision-related activity limitation (VRAL) postoperatively. METHODS: This cohort study with intervention (survey) included 1329 patients in Sweden who had undergone a second-eye cataract surgery during March 2013. Data from the Swedish National Cataract Register were used, including evaluations of VRAL through the Catquest-9SF questionnaire before and 3 months after cataract surgery. Five months after the second-eye surgery, patients completed another five-item questionnaire about spectacle use preoperatively and postoperatively including an item on surgeons' advice about the need for spectacles. These responses were linked to the Rasch-analysed Catquest-9SF data to identify correlations with VRAL. RESULTS: A total of 1239 patients finally participated in the study after excluding those who did not fulfil the inclusion criteria. Patients who were advised about the need for spectacles postoperatively (n = 387) had a greater (p = 0.039) improvement in the postoperative VRAL compared to patients who were not advised (n = 691). Patients who obtained new spectacles postoperatively (n = 512) also had greater improvement (p = 0.032) compared to those who did not (n = 724). CONCLUSION: The average improvements in the VRAL after surgery were significantly higher for patients who obtained new distance spectacles postoperatively and for patients who were informed about the need for spectacles by their practitioners.
Assuntos
Atividades Cotidianas , Extração de Catarata/reabilitação , Óculos/estatística & dados numéricos , Satisfação do Paciente , Erros de Refração/reabilitação , Acuidade Visual , Idoso , Avaliação da Deficiência , Feminino , Humanos , Masculino , Período Pós-Operatório , Qualidade de Vida , Erros de Refração/etiologia , Erros de Refração/fisiopatologia , Inquéritos e QuestionáriosRESUMO
PURPOSE: To explore patients' obtaining and use of spectacles after routine cataract surgery. METHODS: The study included 1329 patients who underwent bilateral surgery with the second eye operated during March 2013 at 38 different clinics in Sweden. Five months after the second-eye surgery, patients completed a five-item questionnaire about their spectacle use preoperatively and postoperatively. The responses were linked to data from the registry on multiple variables including postoperative refraction, age and gender. RESULTS: Of the 387 patients who were advised by their surgeons to obtain distance spectacles postoperatively, most did so (77.3%, n = 299), while of the 691 patients who were not so advised, most did not obtain spectacles (78.9%, n = 545). Nevertheless, almost 50% of patients with both spherical and cylindrical errors exceeding 1 dioptre (D) did not obtain new distance spectacles postoperatively, while about 25% of patients with bilateral emmetropia (spherical error <0.5 D, cylinder <1 D) obtained new distance spectacles postoperatively. CONCLUSION: Patients' choices regarding obtaining and using new spectacles postoperatively are strongly correlated with advice given by the surgeon about the need for distance correction. The large difference between groups who were and were not advised to obtain spectacles for distance correction was only partially reflected in the postoperative refractive errors. Similarly, the patterns of preoperative spectacle use and gender or age differences did not explain this difference.
Assuntos
Extração de Catarata , Óculos/estatística & dados numéricos , Refração Ocular/fisiologia , Erros de Refração/reabilitação , Sistema de Registros , Idoso , Feminino , Humanos , Incidência , Masculino , Período Pós-Operatório , Erros de Refração/epidemiologia , Erros de Refração/fisiopatologia , Suécia/epidemiologiaRESUMO
OBJECTIVES: To assess visual function in patients with irregular cornea who do not tolerate gas permeable (GP) corneal contact lenses and are fitted with GP scleral contact lenses (Rose K2 XL). METHODS: In this prospective study, we analyzed 15 eyes of 15 patients who did not tolerate GP corneal contact lenses and were fitted with scleral contact lenses (Rose K2 XL). We assessed visual function using visual acuity and the visual function index (VF-14); we used the VF-14 as an indicator of patient satisfaction. The measurements were taken with the optical correction used before and 1 month after the fitting of the Rose K2 XL contact lenses. We also recorded the number of hours lenses had been worn over the first month. RESULTS: Using Rose K2 XL contact lenses, visual acuity was 0.06±0.07 logMAR. In all cases, visual acuity had improved compared with the measurement before fitting the lenses (0.31±0.18 logMAR; P=0.001). VF-14 scores were 72.74±12.38 before fitting of the scleral lenses, and 89.31±10.87 after 1 month of lens use (P=0.003). Patients used these scleral lenses for 9.33±2.99 comfortable hours of wear. CONCLUSIONS: Both visual acuity and VF-14 may improve after fitting Rose K2 XL contact lenses in patients with irregular corneas. In addition, in our patients, these lenses can be worn for a longer period than GP corneal contact lenses.
Assuntos
Lentes de Contato , Ceratocone/complicações , Erros de Refração/reabilitação , Acuidade Visual , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Erros de Refração/etiologia , Erros de Refração/fisiopatologia , Esclera , Acuidade Visual/fisiologiaRESUMO
OBJECTIVE: To evaluate the factors affecting clinical outcomes of correcting cumulative refractive errors or irregular astigmatism after radial keratotomy (RK) using mini-scleral lenses. METHODS: We retrospectively analyzed 36 eyes receiving mini-scleral lenses after RK from July 2011 to June 2016. Analyses included age, refractive errors, best spectacle-corrected visual acuity (BSCVA), best contact lens-corrected visual acuity (BCLCVA), topographic indices, RK treatment zone diameter (TZD), power difference (PrD) within the RK treatment zone, and decentration distance (DD) of the RK treatment zone center. An increase of three lines or more of Snellen visual acuity was considered a successful fitting. RESULTS: Of the eyes fitted with mini-scleral lenses, the BCLCVA (logarithm of the minimum angle of resolution [logMAR] 0.19±0.22) was significantly better than the BSCVA (logMAR 0.47±0.30). Twenty-three patients (64%) had a successful fitting. There was no statistically significant difference between successful and unsuccessful fittings with regard to age, prefitting refractive error, BSCVA, corneal astigmatism, simulated steep/flat K values, surface regularity index, TZD, or PrD. However, successful fittings had better centration of treatment zones with an average DD of 0.54±0.44 mm compared with a DD of 0.92±0.53 mm in the unsuccessfully fitted eyes. In addition, our case series showed that there was a negative impact on fitting outcomes in the presence of small central clear zones resulting from central incisions or scars. CONCLUSIONS: Although decentration of the RK treatment zone and small central clear zones were related to less optimal fitting results, mini-scleral lenses are a feasible option to correct cumulative refractive errors and irregular astigmatism in post-RK patients.