Testing the reliability of an eye-dedicated triaging system: the RESCUE.

PURPOSE: To calculate the reliability of an eye-dedicated triaging system named Rome Eye Scoring System for Urgency and Emergency (RESCUE). METHODS: There were four coding parameters: pain, redness, loss of vision, and risk of open globe. Each parameter is assigned a score, the sum of which allows color coding. There were 1000 consecutive patients divided into urgent (U) or non-urgent (NU) based upon diagnosis, need for treatment, hospitalization, and/or follow-up visit. Correlation between RESCUE triage scoring as assigned by the nurse on presentation and urgency as estimated retrospectively was calculated. Accuracy, sensitivity, and specificity have been calculated. False positives (FP) have been defined as patients assigned a RESCUE green or yellow code while retrospectively judged NU and false negatives (FN) have been defined as patients assigned a white code despite being considered U. RESULTS: Of 1000 patients, 332 (33.2%) were classified as U and 668 (66.8%) NU. The difference in RESCUE scoring between U and NU patients was significant (p<0.001), as well as the correlation between RESCUE scoring and urgency status. Accuracy was 95% with 9.3% FP and 2.7% FN. Sensitivity was 90.7% and specificity 97.2%. Positive predictive value was 94.6%, and negative predictive value was 95.2%. All 32 hospitalized patients and 147/198 (74.2%) patients given a return appointment properly received a yellow or green code. CONCLUSIONS: RESCUE accuracy, sensitivity, and specificity yield encouraging results, confirming the system''s ability to properly spot the most urgent cases. The concept of urgency in ophthalmology can be difficult to establish; nonetheless, an eye-dedicated triage can help in properly prioritizing urgent patients.

Direct costs of glaucoma and severity of the disease: a multinational long term study of resource utilisation in Europe.

BACKGROUND: Resource utilisation and direct costs associated with glaucoma progression in Europe are unknown. As population progressively ages, the economic impact of the disease will increase. METHODS: From a total of 1655 consecutive cases, the records of 194 patients were selected and stratified by disease severity. Record selection was based on diagnoses of primary open angle glaucoma, glaucoma suspect, ocular hypertension, or normal tension glaucoma; 5 years minimum follow up were required. Glaucoma severity was assessed using a six stage glaucoma staging system based on static threshold visual field parameters. Resource utilisation data were abstracted from the charts and unit costs were applied to estimate direct costs to the payer. Resource utilisation and estimated direct cost of treatment, per person year, were calculated. RESULTS: A statistically significant increasing linear trend (p = 0.018) in direct cost as disease severity worsened was demonstrated. The direct cost of treatment increased by an estimated 86 for each incremental step ranging from 455 euro per person year for stage 0 to 969 euro per person year for stage 4 disease. Medication costs ranged from 42% to 56% of total direct cost for all stages of disease. CONCLUSIONS: These results demonstrate for the first time in Europe that resource utilisation and direct medical costs of glaucoma management increase with worsening disease severity. Based on these findings, managing glaucoma and effectively delaying disease progression would be expected to significantly reduce the economic burden of this disease. These data are relevant to general practitioners and healthcare administrators who have a direct influence on the distribution of resources.

Quantitative determination of faecal fat, nitrogen and water by means of a spectrophotometric technique: near infrared reflectance analysis (NIRA). Assessment of its accuracy and reproducibility compared with chemical methods.

Measurement in faeces of the principal nutrients, fat (F), water (W) and nitrogen (N) is useful to assess digestive and absorptive functions and thus to monitor patients' progress and response to therapy in malabsorption/maldigestion syndromes. Presently available techniques are not ideal in clinical practice for serial analysis as they are time-consuming and require unpleasant and prolonged handling of the stools. The present study aimed to evaluate the accuracy and precision of near infrared reflectance analysis (NIRA) in routine measurement of fat, nitrogen and water faecal contents compared with Van de Kamer (VDK), Kjeldahl (KJ) and gravimetric-by-lyophilization (LY) methods, respectively. Fat, nitrogen and water (n = 34), were measured in the 1-day faecal collections of 15 healthy subjects and 19 patients (10, coeliac disease; 6, chronic pancreatitis; 3, small-bowel Crohn's disease). A highly significant linear correlation was found between VDK, KJ, LY methods and NIRA analysis. Very low values of intra-assay coefficient of variation indicated a remarkable analytical precision of NIRA. A recovery test at different concentrations in the useful range was performed for all three nutrients, to assess the accuracy of NIRA. Quantitative recoveries were between 95 and 105%. Data from the present study show that NIRA analysis is reproducible, accurate and rapid (less than 1 min). These characteristics make NIRA serial analysis useful in clinical practice to monitor progress and response to therapy in patients with malabsorption/maldigestion syndromes.

Standardized measurement of visual acuity.

The authors reviewed the main aspects of visual acuity evaluation such as the characteristics of the test devices, the notation employed in recording the visual acuity level and the procedures for V.A. assessment, in both distance and near tests. In addition, new ten-letter charts, that tend to follow strictly the standardization guideline suggested by NAS-NRC, are described.

Prevalence of glaucoma in Ponza, Italy: a comparison with other studies.

The purpose of this study was to determine the prevalence of glaucoma in Ponza, Italy. The design was a population-based prevalence survey of residents of Ponza aged 40 years or older. There were 1,296 official residents identified by a house-to-house census, of whom 1,226 were identified as eligible for the study. Of these, 1,034 individuals (449 males and 585 females), or 84.3% of the eligible population, participated in the ophthalmological examination. A two-stage method was adopted to identify cases of glaucoma. All subjects underwent a standardized initial examination. Glaucoma suspects and 50% of non-suspects were referred to a definitive examination which included visual field testing. Patients were defined as glaucoma cases if they presented abnormal visual fields and at least one of the following: high 10P, large or asymmetric cup-to-disc ratio. In addition to typical glaucomatous visual field defects such as paracentral scotoma, nasal step, arcuate scotoma and temporal and/or central islands fields, a visual field defect was identified as a decrease in sensitivity greater than 6 db in at least one location of the central 10 degrees, two locations of the central 20 degrees or three locations of the central 30 degrees. Prevalence rates of 2.51% of Primary Open Angle Glaucoma (1.72%-3.66%, CI 95%), 0.97% of Primary Closed Angle Glaucoma (0.53%-1.77%, CI 95%) and 0.29% of secondary glaucoma were found. Moreover, 2.13% of probable POAG (1.41%-3.20%, CI 95%) and 6.00% of High Intraocular Pressure (4.71%-7.61%, CI 95%) were found. The prevalence rates of POAG found in the Ponza Ophthalmological Survey are consistent with the results of other studies. Minor differences are most likely due to the different criteria adopted in the assessment of glaucomatous visual field damage.

Prevalence and incidence of age-related cataract in a population sample from Priverno, Italy.

PURPOSE: To study the prevalence and incidence of age-related cataract in a random population sample from the town of Priverno in the Lazio Region, Italy. METHODS: In 1987, 860 people between the ages of 45 and 69 years, already participating in a study on cardiovascular risk factors, underwent an ophthalmological examination. Patients with lens opacities, assessed by a clinical biomicroscopy and a best-corrected VA equal to or worse than 0.2 LogMar (20/30), were defined as age-related cataract cases. Of the 828 patients without age-related cataract at the baseline, 602 were re-examined in 1994. The 7-year Cumulative Incidence was calculated in three ways, as follows: - referring to the baseline sample without age-related cataract; - referring to the follow-up sample without age-related cataract at baseline; and - adjusted for non-response to the follow-up. RESULTS: In the baseline sample, the prevalence of age-related cataract was 3.7% (2.7%-5.2%, 95% C.I.). Cumulative Incidence referring to the baseline sample was 6.5% (4. 8%-8.2%, 95% C.I.); Cumulative Incidence referring to the follow-up sample was 9.0% (6.7%-11.3%, 95% C.I.). Adjusted Cumulative Incidence of age-related cataract was 7.6% (5.6%-9.5%, 95% C.I.). CONCLUSIONS: The study suggests that, in the Priverno sample, aging, but not gender, is a very important risk factor for cataract. The authors conclude that more information is needed on incidence of age-related cataract needing surgical rehabilitation and on risk factors causing both progression of lens opacities and visual loss.

Age-specific changes in the prevalence and management of optically correctable visual impairment between 1988 and 2000: the Ponza Eye Study.

PURPOSE: To obtain age-specific data on changes in the prevalence and management of optically correctable visual impairments (OCVIs) in Ponza, Italy. METHODS: Ophthalmologic examinations were carried out to 1000 Ponzans aged 40-87 years in 1988 and to 836 persons in 2000. Visual acuity (VA) was evaluated under uncorrected (VA(UC)), presenting (VA(PR)), and best-corrected (VA(BC)) conditions. We calculated the prevalence of total OCVIs (subjects with VA(UC)>0.5 logMAR and VA(BC)0.5 logMAR), and corrected OCVIs (VA(PR)

Prevalence of blindness and low vision in an Italian population: a comparison with other European studies.

AIM: The scientific literature contains recent data on the prevalence of blindness and low vision for a few European countries, but most of these studies have been focused exclusively on the elderly sector of the populations. The purpose of the present study was to provide age-specific estimates of the prevalence and causes of visual loss in an Italian population aged 40 years and over. METHODS: In total, 847 of the 1,200 citizens >40 years of age (70.6%) in the island community of Ponza underwent complete standardized ophthalmological examinations. Visual acuity (VA) was measured using a standard logarithmic chart. World health organization (WHO) definitions of blindness and low vision were adopted (respectively, VA>1.3 logMAR or a visual field <10 degrees around central fixation, and VA >0.5 to 1.3 logMAR or a visual field <20 degrees around central fixation). Prevalence rates based on presenting VAs were also calculated. RESULTS: The overall best-corrected prevalence rates were 0.6% (presenting, 0.8%) for better eye blindness, 2.1% (presenting, 6.7%) for better eye low vision, 1.8% (presenting, 2.6%) for monocular blindness, 5.0% (presenting, 11.2%) for monocular low vision. Cataract, glaucoma, degenerative myopia, and AMD were the main causes of better eye visual loss. CONCLUSION: Age-specific prevalence rates in Ponza are fairly consistent with those for other European countries with similar socio-economic conditions and public healthcare systems. A substantial percentage of visual losses remains uncorrected despite the availability of potentially curative therapy. Greater emphasis needs to be placed on educating the public regarding the importance of good vision.

Incidence of visual loss in the Ponza Eye Study, Italy.

AIM: To study the incidence of visual loss over a 12-year period in the survivors of an original cohort aged 40 years or older at baseline. METHODS: Visual acuity (VA) was measured by means of a standardized logMAR chart. World Health Organization definition of blindness and low vision was adopted (respectively, best-corrected VA >1.3 logMAR or a visual field <10 degrees around central fixation, and best-corrected VA >0.5-1.3 logMAR or a visual field <20 degrees around central fixation). Moreover, binocular visual loss incidence (VA>0.5 logMAR) was calculated in a 'healthy' group who had uncorrected VA of 0.0 logMAR or better in both eyes at baseline and absence of eye diseases. RESULTS: Of the 584 eligible survivors, 411 (70.7%) had a 12-year follow-up visit. The overall incidence figures were as follows: best-corrected binocular blindness (0.7%), binocular low vision (3.9%), monocular blindness (2.7%), and monocular low vision (5.0%), respectively. The results for presenting VAs were 1.2, 9.5, 4.2, and 15.3%. Figures for uncorrected, best-corrected, and presenting binocular visual loss incidence in the 'healthy' group were respectively 12.7, 0.9, and 3.7%. CONCLUSION: The discrepancy between the ideal and real situations that emerges from this study has important implications for health-care planning. Over a period of 12 years, a substantial percentage of 'healthy' subjects will have to seek medical care. Incident visual loss was caused mainly by untreated cataract, glaucoma, myopia, and age-related macular degeneration.

The Italian support to prevention of blindness programmes in developing countries.

The authors point out that Italy, as a tradition, has always dedicated special attention to developing countries, due to its geographical position and its cultural background and that in 1971 the Italian Government has created by a law, as part of the Ministry of Foreign Affairs, the Department for Cooperation and Development, the objective of which is to contribute to the enhancement of the living conditions in developing countries. The authors report data on a Trachoma Control Project started in 1973 lasting to 1981, financially supported by the Ministry of Foreign Affairs and technically guided by some of the authors and point out that the major success of this Project is that, since they left the Country in 1981, trachoma control activities are still now carried out by using the same methodologies. Finally, the authors report data on a National Prevention of Blindness Programme, the extension of which will be guided in the near future by the Referral Center for Public Health Ophthalmology of Rome that has just prepared the plan of operation that foresees the reorganization and strengthening of the existing structures and manpower at the head quarter, tertiary, secondary and primary levels.

Use of bendazac lysine to limit protein deposition on soft contact lenses in vitro.

We used the heat denaturation of lysozyme to induce the in vitro formation of protein deposits on 60 poly-HEMA contact lenses (38.6% water). Each lens was individually placed in 20 mL of a 0.04% lysozyme solution. The lenses were divided into two equal groups. In the first group (30 lenses), bendazac lysine (100 mg) was added to the lysozyme solution. The second group of lenses was used as control. Quantitative analysis of protein deposits on the lenses of both groups was carried out by a colorimetric test. In the lenses where deposit formation occurred in the presence of bendazac lysine, a mean protein level of 7.17 +/- 3.42 micrograms per lens was found; in the control group the mean value was 30.6 +/- 8.22 micrograms per lens. Student's t-test showed this difference to be significant (P less than 0.001).

The ophthalmologist's role in Chlamydia trachomatis infection.

Chlamydia Trachomatis (C.T.) most commonly causes cervicitis in women, often without overt symptoms; when untreated, it produces a clinically inapparent but persistent mild infection or an evident salpingitis. Either processes may lead to scarring of the falloppian tubes and fertility problems. A group of 30 women 20-35 years aged has undergone an ophthalmological routine examination; 7 of them presented a chronical follicular conjunctivitis and history of yellow-white cervical discharge, while the remaining 23 had a mild chronical follicular conjunctivitis but not genital symptoms. Each patient has undergone an immunofluorescent test with monoclonal antibody specific for C.T. on the samples collected by genital and conjunctival scraping and cytological evaluation of the above samples with Giemsa staining. 6 out of 7 patients with genital discharge were positive for C.T., one of which even for eye samples too; all eyes samples showed lymphomonocytes and neutrofilic cells in their eye samples. An additional 3 cases negative for C.T. showed this kind of cells in the eye scraping. The preliminary results of this study on mild follicular chronical conjunctivitis suggest that the Ophthalmologist could play an important role in order to make an early diagnosis in genital and eye infection by Chlamydial Trachomatis.

Quantitative analysis of stool losses in adult celiac disease: use of near-infrared analysis reconsidered.

BACKGROUND: An attempt has been made to establish whether near-infrared stool analysis is more suitable for quantifying malabsorption than the traditional stool fat analysis. A group of celiac disease (CD) patients was used as index population. METHODS: Stool fat, nitrogen, and water were measured with near-infrared analysis of 1- and 3-day stool collections in 96 celiac disease patients on a free diet (in 39 also on gluten-free diet) and in 96 matched controls and 14 patients with latent CD. RESULTS: The fecal output of fat, nitrogen, and water was significantly increased in free-diet CD, whereas their percentage content was only slightly modified compared with controls. None of the variables under consideration differed significantly between the 24-h and 72-h stool specimens. CONCLUSION: Our data show that the high value of fecal fat, nitrogen, and water, in celiac disease, are mainly due to the fecal weight, whereas the percentage composition of stool does not offer additional diagnostic information. Furthermore, 3-day stool collection is not necessary to confirm or rule out malabsorption in most patients. Near infrared analysis of 24-h specimens is time- and cost-effective and may increase the use of stool analysis and be usefully employed to monitor the clinical follow-up of patients with chronic diarrhea.