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1.
Postgrad Med J ; 99(1169): 198-206, 2023 May 19.
Artículo en Inglés | MEDLINE | ID: mdl-37222061

RESUMEN

PURPOSE: To assess British doctors' work-life balance, home-life satisfaction and associated barriers. STUDY DESIGN: We designed an online survey using Google Forms and distributed this via a closed social media group with 7031 members, exclusively run for British doctors. No identifiable data were collected and all respondents provided consent for their responses to be used anonymously. The questions covered demographic data followed by exploration of work-life balance and home-life satisfaction across a broad range of domains, including barriers thereto. Thematic analysis was performed for free-text responses. RESULTS: 417 doctors completed the survey (response rate: 6%, typical for online surveys). Only 26% reported a satisfactory work-life balance; 70% of all respondents reported their work negatively affected their relationships and 87% reported their work negatively affected their hobbies. A significant proportion of respondents reported delaying major life events due to their working patterns: 52% delaying buying a home, 40% delaying marriage and 64% delaying having children. Female doctors were most likely to enter less-than-full-time working or leave their specialty. Thematic analysis revealed seven key themes from free-text responses: unsocial working, rota issues, training issues, less-than-full-time working, location, leave and childcare. CONCLUSIONS: This study highlights the barriers to work-life balance and home-life satisfaction among British doctors, including strains on relationships and hobbies, leading to many doctors delaying certain milestones or opting to leave their training position altogether. It is imperative to address these issues to improve the well-being of British doctors and improve retention of the current workforce.


Asunto(s)
Medicina , Médicos , Niño , Humanos , Femenino , Estudios Transversales , Equilibrio entre Vida Personal y Laboral , Salud Infantil
2.
J Neuroophthalmol ; 41(2): e200-e201, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-32956229

RESUMEN

ABSTRACT: We present handheld optical coherence tomography (OCT) diagnosis of Grade 4 foveal hypoplasia (fovea plana) in a 28-day-old infant with albinism. Grade 4 foveal hypoplasia is characterized by the absence of the foveal pit, absence of outer segment lengthening, and absence of outer nuclear layer widening. Binocular visual acuity at 58 months follow-up was 1.2 logarithm of the minimal angle of resolution (logMAR). We describe our handheld OCT acquisition protocol and compare the morphological features with a healthy, age-matched control subject.


Asunto(s)
Anomalías Múltiples , Albinismo/diagnóstico , Computadoras de Mano , Anomalías del Ojo/diagnóstico , Fóvea Central/anomalías , Tomografía de Coherencia Óptica/métodos , Fóvea Central/diagnóstico por imagen , Humanos , Recién Nacido , Masculino
3.
Postgrad Med J ; 2021 Dec 17.
Artículo en Inglés | MEDLINE | ID: mdl-37073616

RESUMEN

PURPOSE: To assess British doctors' work-life balance, home-life satisfaction and associated barriers. STUDY DESIGN: We designed an online survey using Google Forms and distributed this via a closed social media group with 7031 members, exclusively run for British doctors. No identifiable data were collected and all respondents provided consent for their responses to be used anonymously. The questions covered demographic data followed by exploration of work-life balance and home-life satisfaction across a broad range of domains, including barriers thereto. Thematic analysis was performed for free-text responses. RESULTS: 417 doctors completed the survey (response rate: 6%, typical for online surveys). Only 26% reported a satisfactory work-life balance; 70% of all respondents reported their work negatively affected their relationships and 87% reported their work negatively affected their hobbies. A significant proportion of respondents reported delaying major life events due to their working patterns: 52% delaying buying a home, 40% delaying marriage and 64% delaying having children. Female doctors were most likely to enter less-than-full-time working or leave their specialty. Thematic analysis revealed seven key themes from free-text responses: unsocial working, rota issues, training issues, less-than-full-time working, location, leave and childcare. CONCLUSIONS: This study highlights the barriers to work-life balance and home-life satisfaction among British doctors, including strains on relationships and hobbies, leading to many doctors delaying certain milestones or opting to leave their training position altogether. It is imperative to address these issues to improve the well-being of British doctors and improve retention of the current workforce.

4.
J Craniofac Surg ; 32(1): 201-205, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33185414

RESUMEN

OBJECTIVE: Craniosynostosis can be associated with raised intracranial pressure (ICP), which can pose deleterious effects on the brain and vision if untreated. Estimating ICP in children is challenging, whilst gold standard direct intracranial measurement of ICP is invasive and carries risk. This systematic review aims to evaluate the role of optical coherence tomography (OCT), a noninvasive imaging technique, for detecting raised ICP in children with craniosynostosis. METHODS: The authors conducted a systematic review of the literature published from inception until 19 August, 2019 in the Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, and EMBASE. Eligible studies evaluated the role of OCT in detecting raised ICP in children aged 0 to 16 years with craniosynostosis. Main outcome measures were sensitivity and specificity of OCT parameters for raised ICP. Quality assessment was performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. RESULTS: Out of 318 records identified, data meeting the inclusion criteria were obtained from 3 studies. The quality of 2 studies was poor whilst 1 was fair. Optical coherence tomography demonstrated higher sensitivity and specificity for detecting raised ICP compared to fundus examination, clinical history, radiological testing, and visual field testing. CONCLUSIONS: This systematic review demonstrated a lack of quality evidence for OCT as a screening tool for children with craniosynostosis. Further research is required to clarify the strength of OCT in this role and to determine which OCT parameters are most appropriate.


Asunto(s)
Craneosinostosis , Hipertensión Intracraneal , Niño , Craneosinostosis/diagnóstico por imagen , Estudios Transversales , Humanos , Hipertensión Intracraneal/diagnóstico por imagen , Presión Intracraneal , Tomografía de Coherencia Óptica
5.
Ophthalmology ; 127(4): 492-500, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31937464

RESUMEN

PURPOSE: To evaluate structural grading and quantitative segmentation of foveal hypoplasia using handheld OCT, versus preferential looking (PL), as predictors of future vision in preverbal children with infantile nystagmus. DESIGN: Longitudinal cohort study. PARTICIPANTS: Forty-two patients with infantile nystagmus (19 with albinism, 17 with idiopathic infantile nystagmus, and 6 with achromatopsia) were examined. METHODS: Spectral-domain handheld OCT was performed in preverbal children up to 36 months of age. Foveal tomograms were graded using our 6-point grading system for foveal hypoplasia and were segmented for quantitative analysis: photoreceptor length, outer segment (OS) length, and foveal developmental index (FDI; a ratio of inner layers versus total foveal thickness). Patients were followed up until they could perform chart visual acuity (VA) testing. Data were analyzed using linear mixed regression models. Visual acuity predicted by foveal grading was compared with prediction by PL, the current gold standard for visual assessment in infants and young children. MAIN OUTCOME MEASURES: Grade of foveal hypoplasia, quantitative parameters (photoreceptor length, OS length, FDI), and PL VA were obtained in preverbal children for comparison with future chart VA outcomes. RESULTS: We imaged 81 eyes from 42 patients with infantile nystagmus of mean age 19.8 months (range, 0.9-33.4 months; standard deviation [SD], 9.4 months) at the first handheld OCT scan. Mean follow-up was 44.1 months (range, 18.4-63.2 months; SD, 12.0 months). Structural grading was the strongest predictor of future VA (grading: r = 0.80, F = 67.49, P < 0.0001) compared with quantitative measures (FDI: r = 0.74, F = 28.81, P < 0.001; OS length: r = 0.65; F = 7.94, P < 0.008; photoreceptor length: r = 0.65; F = 7.94, P < 0.008). Preferential looking was inferior to VA prediction by foveal grading (PL: r = 0.42, F = 3.12, P < 0.03). CONCLUSIONS: Handheld OCT can predict future VA in infantile nystagmus. Structural grading is a better predictor of future VA than quantitative segmentation and PL testing. Predicting future vision may avert parental anxiety and may optimize childhood development.


Asunto(s)
Anomalías del Ojo/patología , Fóvea Central/anomalías , Enfermedades Genéticas Ligadas al Cromosoma X/diagnóstico , Nistagmo Congénito/diagnóstico , Trastornos de la Visión/diagnóstico , Albinismo Oculocutáneo/diagnóstico , Albinismo Oculocutáneo/fisiopatología , Preescolar , Defectos de la Visión Cromática/diagnóstico , Defectos de la Visión Cromática/fisiopatología , Anomalías del Ojo/clasificación , Femenino , Estudios de Seguimiento , Fóvea Central/diagnóstico por imagen , Enfermedades Genéticas Ligadas al Cromosoma X/fisiopatología , Humanos , Lactante , Estudios Longitudinales , Masculino , Nistagmo Congénito/fisiopatología , Estudios Prospectivos , Tomografía de Coherencia Óptica , Trastornos de la Visión/fisiopatología , Agudeza Visual/fisiología
6.
J Public Health (Oxf) ; 42(3): 510-516, 2020 Aug 18.
Artículo en Inglés | MEDLINE | ID: mdl-32309854

RESUMEN

BACKGROUND: It is crucial that world leaders mount effective public health measures in response to COVID-19. Twitter may represent a powerful tool to help achieve this. Here, we explore the role of Twitter as used by Group of Seven (G7) world leaders in response to COVID-19. METHODS: This was a qualitative study with content analysis. Inclusion criteria were as follows: viral tweets from G7 world leaders, attracting a minimum of 500 'likes'; keywords 'COVID-19' or 'coronavirus'; search dates 17 November 2019 to 17 March 2020. We performed content analysis to categorize tweets into appropriate themes and analyzed associated Twitter data. RESULTS: Eight out of nine (88.9%) G7 world leaders had verified and active Twitter accounts, with a total following of 85.7 million users. Out of a total 203 viral tweets, 166 (82.8%) were classified as 'Informative', of which 48 (28.6%) had weblinks to government-based sources, while 19 (9.4%) were 'Morale-boosting' and 14 (6.9%) were 'Political'. Numbers of followers and viral tweets were not strictly related. CONCLUSIONS: Twitter may represent a powerful tool for world leaders to rapidly communicate public health information with citizens. We would urge general caution when using Twitter for health information, with a preference for tweets containing official government-based information sources.


Asunto(s)
Comunicación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Salud Global/normas , Difusión de la Información/métodos , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Salud Pública/normas , Medios de Comunicación Sociales , Adulto , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Guías de Práctica Clínica como Asunto , Investigación Cualitativa , SARS-CoV-2
8.
Eye (Lond) ; 37(13): 2649-2658, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-36828959

RESUMEN

Amblyopia is an important public health concern. While home-based screening may present an effective solution, this has not been rigorously assessed in a systematic review. A systematic review was performed using Ovid MEDLINE, PubMed, The Cochrane Library, Embase, Web of Science Core Collection, and Clinicaltrials.gov. All studies reporting the diagnostic accuracy of home-based screening tools for amblyopia among children were included. Studies involving orthoptist or ophthalmologist-led screening and adult subjects were excluded. The main outcome measure was the diagnostic accuracy expressed as sensitivity and specificity. Among 3670 studies identified, 28 were eligible for inclusion in our systematic review. The age range of patients were less than 1 month to 16 years old. 7 studies used internet-based tools, 16 used smartphone/tablet applications, 3 used digital cameras, and 3 used home-based questionnaires and visual acuity tools. All studies included a reference standard except one, which was a longitudinal study. 21 studies had full ophthalmological examination whilst 6 studies had validated visual acuity measurement tools as gold standards. Of the 27 studies which compared against a reference test, only 25 studies reported sensitivity and specificity values. Using the QUADAS-2 tool, 50% of studies were deemed to have applicability concern due to patient selection from tertiary centres and unclear methods for recruitment. There is a need to improve the quality of diagnostic accuracy studies, standardise thresholds for detecting amblyopia, and ensure consistent reporting of results. Further research is needed to evaluate the suitability of these tools for amblyopia screening.


Asunto(s)
Ambliopía , Adulto , Niño , Humanos , Lactante , Ambliopía/diagnóstico , Estudios Longitudinales , Sensibilidad y Especificidad , Examen Físico
9.
Eye (Lond) ; 37(1): 139-145, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-34974540

RESUMEN

AIMS: To assess the diagnostic accuracy of fundoscopy and visual evoked potentials (VEPs) in detecting intracranial hypertension (IH) in patients with craniosynostosis undergoing spring-assisted posterior vault expansion (sPVE). METHODS: Children with craniosynostosis undergoing sPVE and 48-hour intracranial pressure (ICP) monitoring were included in this single-centre, retrospective, diagnostic accuracy study. Data for ICP, fundoscopy and VEPs were analysed. Primary outcome measures were papilloedema on fundoscopy, VEP assessments and IH, defined as mean ICP > 20 mmHg. Diagnostic indices were calculated for fundoscopy and VEPs against IH. Secondary outcome measures included final visual outcomes. RESULTS: Fundoscopic examinations were available for 35 children and isolated VEPs for 30 children, 22 of whom had at least three serial VEPs. Sensitivity was 32.1% for fundoscopy (95% confidence intervals [CI]: 15.9-52.4) and 58.3% for isolated VEPs (95% CI 36.6-77.9). Specificity for IH was 100% for fundoscopy (95% CI: 59.0-100) and 83.3% for isolated VEPs (95% CI: 35.9-99.6). Where longitudinal deterioration was suspected from some prVEPs but not corroborated by all, sensitivity increased to 70.6% (95% CI: 44.0-89.7), while specificity decreased to 60% (95% CI: 14.7-94.7). Where longitudinal deterioration was clinically significant, sensitivity decreased to 47.1% (23.0-72.2) and specificity increased to 100% (47.8-100). Median final BCVA was 0.24 logMAR (n = 36). UK driving standard BCVA was achieved by 26 patients (72.2%), defined as ≥0.30 logMAR in the better eye. CONCLUSION: Papilloedema present on fundoscopy reliably indicated IH, but its absence did not exclude IH. VEP testing boosted sensitivity at the expense of specificity, depending on method of analysis.


Asunto(s)
Craneosinostosis , Hipertensión Intracraneal , Papiledema , Niño , Humanos , Papiledema/diagnóstico , Estudios Retrospectivos , Potenciales Evocados Visuales , Hipertensión Intracraneal/diagnóstico , Craneosinostosis/diagnóstico
10.
BMJ Open ; 12(5): e059038, 2022 05 18.
Artículo en Inglés | MEDLINE | ID: mdl-35584878

RESUMEN

INTRODUCTION: Cytomegalovirus (CMV) is one of the most common congenitally acquired infections worldwide. Visual impairment is a common outcome for symptomatic infants, with long-term ophthalmic surveillance often recommended. However, there are no clear guidelines for ophthalmic surveillance in infants with asymptomatic disease. We aim to conduct a systematic review to establish the overall prevalence and incidence of eye and vision related disorders following congenital CMV infection (cCMV). METHODS AND ANALYSIS: A systematic review and meta-analysis (pending appropriate data for analysis) of cross-sectional and longitudinal studies will be conducted. The PubMed, Embase and CINAHL databases will be searched up to 29 March 2022 without date or language restrictions. Studies will be screened by at least two independent reviewers. Methodological quality of included studies will be assessed using the Joanna Briggs Institute tool. The primary outcome measures will be incidence and/or prevalence of vision impairment or ophthalmic disorders in patients with symptomatic and asymptomatic cCMV infection. A narrative synthesis will be conducted for all included studies. The overall prevalence will be estimated by pooling data using a random-effects model. Heterogeneity between studies will be estimated using Cochran's Q and the I2 statistics. Egger's test will be used to assess for publication bias. ETHICS AND DISSEMINATION: Ethical approval is not required as there is no primary data collection. Study findings will be disseminated at scientific meetings and through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: This is not a clinical trial, but the protocol has been registered: CRD42021284678 (PROSPERO).


Asunto(s)
Infecciones por Citomegalovirus , Estudios Transversales , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/epidemiología , Humanos , Incidencia , Metaanálisis como Asunto , Prevalencia , Sesgo de Publicación , Proyectos de Investigación , Revisiones Sistemáticas como Asunto
11.
BMJ Open ; 12(1): e048745, 2022 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-35017232

RESUMEN

INTRODUCTION: Paediatric intracranial hypertension (IH) is a rare but serious condition that can pose deleterious effects on the brain and vision. Estimating intracranial pressure (ICP) in children is difficult. Gold standard direct ICP measurement is invasive and carries risk. It is impractical to routinely perform direct ICP measurements over time for all children at risk of IH. This study proposes to assess the diagnostic accuracy of handheld optical coherence tomography (OCT), a non-invasive ocular imaging method, to detect IH in children. METHODS AND ANALYSIS: This is a prospective study evaluating the diagnostic accuracy of handheld OCT for IH in at risk children. Inclusion criteria include clinical and/or genetic diagnosis of craniosynostosis, idiopathic intracranial hypertension, space occupying lesion or other conditions association with IH and age 0-18 years old. Exclusion criteria include patients older than 18 years of age and/or absence of condition placing the child at risk of IH. The primary outcome measures are handheld OCT and 48-hour ICP assessments, which will be used for diagnostic accuracy testing (sensitivity, specificity, positive predictive value, negative predictive value and accuracy). Main secondary outcome measures include visual acuity, fundoscopic examination, contrast sensitivity, visual field testing and visual evoked potentials, wherever possible. ETHICS AND DISSEMINATION: Ethical approval was granted for this study by the East Midlands Nottingham 2 Research Ethics committee (UOL0348/IRAS 105137). Our findings will be disseminated through presentation at relevant meetings, peer-reviewed publication and via the popular media. TRIAL REGISTRATION NUMBER: ISRCTN52858719.


Asunto(s)
Hipertensión Intracraneal , Tomografía de Coherencia Óptica , Adolescente , Niño , Preescolar , Potenciales Evocados Visuales , Humanos , Lactante , Recién Nacido , Hipertensión Intracraneal/diagnóstico por imagen , Presión Intracraneal , Estudios Prospectivos , Tomografía de Coherencia Óptica/métodos
12.
Eye (Lond) ; 36(5): 1005-1011, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-33972704

RESUMEN

OBJECTIVE: To determine visual outcomes and prevalence of amblyogenic risk factors in children with Apert, Crouzon, Pfeiffer and Saethre-Chotzen syndromes. METHODS: We conducted a single-centre, retrospective chart review of patients assessed at our unit between October 2000 and May 2017. Our outcome measures were as follows: age at first and last examination, refraction, horizontal ocular alignment, alphabet pattern deviations, anterior segment appearance, fundus examination findings, visual evoked potentials (VEPs) and genetics. The study's primary endpoint was the proportion of children achieving best-corrected visual acuity (BCVA) ≥ 6/12 in the better eye at final visit, as per UK driving standards. RESULTS: 165 patients were included in this study. Breakdown of diagnoses was as follows: Crouzon (n = 60), Apert (n = 57), Pfeiffer (n = 14) and Saethre-Chotzen (n = 34). 98 patients were male. Of 133 patients with full BCVA data available, 76.7% achieved BCVA ≥ 6/12 in the better eye. Of 122 patients, anisometropia >1.00 dioptre sphere (DS) affected 18.9% and astigmatism ≥1.00DS in at least one eye affected 67.2%. Of 246 eyes, 48.4% had oblique astigmatism. Of 165 patients, 60 had exotropia and 12 had esotropia. 48 of 99 patients demonstrated 'V' pattern. On multivariable logistic regression, nystagmus (p = 0.009) and ON involvement (p = 0.001) were associated with decreased vision in the worse eye. Normal VEPs were associated with better BCVA (p = 0.036). CONCLUSION: There was a high prevalence of amblyogenic factors, however, the majority achieved BCVA ≥ 6/12 in their better eye. Optic neuropathy and nystagmus had the most significant impact on vision. VEPs can help the in overall assessment of visual function.


Asunto(s)
Acrocefalosindactilia , Astigmatismo , Craneosinostosis , Oftalmopatías , Acrocefalosindactilia/complicaciones , Niño , Craneosinostosis/complicaciones , Potenciales Evocados Visuales , Femenino , Humanos , Masculino , Estudios Retrospectivos
13.
BMJ Open ; 11(8): e046935, 2021 08 11.
Artículo en Inglés | MEDLINE | ID: mdl-34380720

RESUMEN

OBJECTIVES: To evaluate the diagnostic capability of optical coherence tomography (OCT) in children aged under 18 years old with intracranial hypertension (IH). DESIGN: Systematic review. METHODS: We conducted a systematic review using the following platforms to search the keywords 'optical coherence tomography' and 'intracranial hypertension' from inception to 2 April 2020: Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PubMed and Web of Science, without language restrictions. Our search returned 2729 records, screened by two independent screeners. Studies were graded according to the Oxford Centre for Evidence-Based Medicine and National Institutes of Health Quality Assessment Tool for observational studies. RESULTS: Twenty-one studies were included. Conditions included craniosynostosis (n=354 patients), idiopathic IH (IIH; n=102), space-occupying lesion (SOL; n=42) and other pathology (n=29). OCT measures included optic nerve parameters, rim parameters (notably retinal nerve fibre layer thickness) and retinal parameters. Levels of evidence included 2b (n=13 studies), 3b (n=4) and 4 (n=4). Quality of 10 studies was fair and 11 poor. There was inconsistency in OCT parameters and reference measures studied, although OCT did demonstrate good diagnostic capability for IH in craniosynostosis, IIH and SOL. CONCLUSIONS: This systematic review identified various studies involving OCT to assist diagnosis and management of IH in children with craniosynostosis, IIH, SOL and other pathology, in conjunction with established clinical measures of intracranial pressure. However, no level 1 evidence was identified. Validating prospective studies are, therefore, required to determine optimal OCT parameters in this role and to develop formal clinical guidelines. PROSPERO REGISTRATION NUMBER: CRD42019154254.


Asunto(s)
Hipertensión Intracraneal , Seudotumor Cerebral , Adolescente , Niño , Humanos , Hipertensión Intracraneal/diagnóstico por imagen , Presión Intracraneal , Estudios Prospectivos , Tomografía de Coherencia Óptica
14.
BMJ Open ; 11(8): e051830, 2021 08 27.
Artículo en Inglés | MEDLINE | ID: mdl-34452969

RESUMEN

INTRODUCTION: Amblyopia is an important public health concern associated with functional vision loss and detrimental impact on the physical and mental well-being of children. The gold standard for diagnosis of amblyogenic conditions currently involves screening by orthoptists and/or ophthalmologists. The bloom of technology enables the use of home-based screening tools to detect these conditions at an early stage by the layperson in community, which could reduce the burden of screening in the community, especially during restrictions associated with the COVID-19 pandemic. Here, we propose a systematic review aiming to evaluate the accuracy and reliability of home-based screening tools compared with the existing gold standard. METHODS AND ANALYSIS: We aim to search for studies involving home-based screening tools for amblyopia among children aged under 18 years. Oxford Centre for Evidence-Based Medicine Level 4 evidence and above will be included, without language or time restrictions. The following platforms will be searched from inception to 31 August 2021: PubMed, Medline, The Cochrane Library, Embase, Web of Science Core Collection and Clinicaltrials.gov. Two independent reviewers will identify studies for inclusion based on a screening questionnaire. The search and screening will start on 14 August 2021 until 1 October 2021. We aim to complete our data analysis by 30 November 2021. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool for diagnostic accuracy studies only. Our primary outcome measure is the diagnostic accuracy of home-based screening tools, while secondary outcome measures include validity, feasibility, reproducibility and cost-effectiveness, where available. ETHICS AND DISSEMINATION: Ethical approval is not necessary as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication. PROSPERO REGISTRATION NUMBER: CRD42021233511.


Asunto(s)
Ambliopía , COVID-19 , Adolescente , Ambliopía/diagnóstico , Niño , Humanos , Pandemias , Reproducibilidad de los Resultados , Proyectos de Investigación , SARS-CoV-2 , Revisiones Sistemáticas como Asunto
15.
J Surg Case Rep ; 2021(2): rjaa606, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33569170

RESUMEN

Craniopagus conjoined twins are extraordinarily rare and present unique challenges to the multidisciplinary team. There is a paucity of literature on optimizing neuro-ophthalmologic evaluation in craniopagus twins. Herein, we present our enhanced neuro-ophthalmologic evaluation and management in 17-month-old male craniopagus twins, uniquely using handheld optical coherence tomography (OCT) plus portable slit-lamp biomicroscopy, indirect ophthalmoscopy and modified forced-choice preferential looking assessment. Staged surgical separation was supported by enhanced neuro-ophthalmologic evaluation, detailed radiology, three-dimensional printing and virtual reality simulation. This represents the fourth separation of craniopagus twins by our unit.

16.
Transl Vis Sci Technol ; 10(8): 24, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34313724

RESUMEN

Purpose: To determine whether handheld optical coherence tomography (OCT) is feasible and repeatable in children with craniosynostosis. Methods: This was a prospective cross-sectional study. Children with syndromic and non-syndromic craniosynostosis 0 to 18 years of age were recruited between February 13, 2020, and October 1, 2020. Main outcome measures included feasibility (patient recruitment and handheld OCT success rates) and repeatability, which were assessed using intraclass correlation coefficients (ICCs) where repeated images of the optic nerve head (ONH) within the same visit were available. ONH parameters used for repeatability analysis included cup depth, width, and area; disc width; rim height; retinal thickness; retinal nerve fiber layer thickness; and Bruch's membrane opening minimum rim width. Results: Fifty children were approached, and all 50 (100%) were successfully recruited. Median age was 51.1 months (range, 1.9-156.9; interquartile range, 37.0-74.2), and 33 of the children (66%) were male. At least one ONH image was obtained in 43 children (86%), and bilateral ONH imaging was successful in 38 children (76%). Factors boosting the likelihood of success included good understanding and cooperation of the child and parent/guardian and availability of an assistant. Repeatability analysis was performed in 20 children, demonstrating good repeatability (ICC range, 0.77-0.99; the majority exceeded 0.90). OCT correctly identified two cases of intracranial hypertension, one of which was undetected by prior fundoscopy. Conclusions: Handheld OCT is feasible and repeatable in children with syndromic and non-syndromic forms of craniosynostosis. Translational Relevance: Our handheld OCT approach could be used for the clinical surveillance of children with craniosynostosis.


Asunto(s)
Craneosinostosis , Tomografía de Coherencia Óptica , Niño , Preescolar , Craneosinostosis/diagnóstico por imagen , Estudios Transversales , Estudios de Factibilidad , Humanos , Masculino , Fibras Nerviosas , Estudios Prospectivos , Reproducibilidad de los Resultados , Células Ganglionares de la Retina
17.
Semin Ophthalmol ; 35(7-8): 343-347, 2020 Nov 16.
Artículo en Inglés | MEDLINE | ID: mdl-33370159

RESUMEN

Background: Precise biometric assessment is crucial in achieving desirable refractive outcomes following cataract surgery. The current evidence for longitudinal biometric changes is lacking. We have performed a cohort study of phakic patients undergoing cataract surgery to help demonstrate whether biometric parameters change over time. Methods: We performed a single-centre, historic cohort study of patients who attended a "two-stop" pre-assessment clinic for consideration of cataract surgery between November 2002 and March 2015. Data were collected retrospectively. Four biometric measurements were recorded: axial length, horizontal (K1) readings, vertical (K2) readings and dioptric power of lens (AR40). Patients were allocated to three groups according to the time interval between initial and latest biometric assessment: Group 1: up to 12 months; Group 2: 12-24 months; Group 3: over 24 months. Results: Data were obtained for 109 eyes from 62 patients. Mean patient age at first biometry was 78 (range: 49-95; S.D.:10). Thirty-eight patients (61.3%) were female. Paired t-tests were performed per biometric measurement per group. No statistically significant changes were observed in Group 1 (n = 9). In Group 2, a statistically significant change was observed in K1 readings (median change: -0.12 mm, range: -0.65 mm to 0.64 mm; P = .002). In Group 3, statistically significant changes were observed in K1 readings (median change: 0.06 mm, range: -0.59 mm to 1.29 mm, P = .03), K2 readings: (median change: 0.33 mm, range: -0.50 mm to 1.09 mm, P < .001) and no change in AR40 readings (median change: 0.00, range -2.00 to 3.00, P = .02). Conclusion: Statistically significant biometric changes were observed over time in this cohort. We recommend considering repeat biometric assessment in patients who have had an interval of longer than 24 months between initial biometric assessment and surgery for optimal refractive outcomes. Further research is required to identify more precisely when to expect changes in the various biometric parameters and which patient characteristics may contribute.


Asunto(s)
Biometría/métodos , Extracción de Catarata , Catarata/fisiopatología , Lentes Intraoculares , Refracción Ocular/fisiología , Anciano , Anciano de 80 o más Años , Longitud Axial del Ojo/diagnóstico por imagen , Catarata/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo
18.
BMJ Open ; 10(7): e037833, 2020 07 06.
Artículo en Inglés | MEDLINE | ID: mdl-32636287

RESUMEN

INTRODUCTION: Intracranial hypertension (ICH) in children can have deleterious effects on the brain and vision. It is notoriously difficult to estimate intracranial pressure (ICP) in children and existing methods deliver suboptimal diagnostic accuracy to be used as screening tools. Optical coherence tomography (OCT) may represent a valuable, non-invasive surrogate measure of ICP, as has been demonstrated in a number of associated conditions affecting adults. More recently, OCT has been employed within the paediatric age group. However, the role of OCT in detecting ICH in children has not been rigorously assessed in a systematic review for all relevant conditions. Here, we propose a systematic review protocol to examine the role of OCT in the detection of ICH in children. METHODS AND ANALYSIS: Electronic searches in the Cochrane Central Register of Controlled Trials, Medline, Embase, Web of Science and PubMed will identify studies featuring OCT in detecting ICH in children. Two independent screeners will identify studies for inclusion using a screening questionnaire. The systematic search and screening will take place between 2 April 2020 and 1 June 2020, while we aim to complete data analysis by 1 September 2020. Quality assessment will be performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The primary outcome measure is the sensitivity and specificity of OCT in detecting ICH in children. Secondary outcomes measures include conditions associated with ICH per study, direct ICP monitoring, sensitivity and specificity of other measures for ICP and OCT parameters used. ETHICS AND DISSEMINATION: Ethical approval is not required for the proposed systematic review as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication. PROSPERO REGISTRATION NUMBER: CRD42019154254.


Asunto(s)
Hipertensión Intracraneal , Tomografía de Coherencia Óptica , Niño , Estudios Transversales , Humanos , Hipertensión Intracraneal/diagnóstico por imagen , Presión Intracraneal , Proyectos de Investigación , Sensibilidad y Especificidad , Revisiones Sistemáticas como Asunto
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