Anxiety levels moderate the association between visual acuity and health-related quality of life in chronic eye disease patients.

The current study examines the potential moderating effect of depression and anxiety on the relationship between visual acuity and health-related quality of life in patients with chronic eye diseases. Of the 71 patients, 37 (52%) were female and 34 (48%) were male, age (mean ± SD) was 69 ± 12 years. A significant multivariate regression model was found for patients' health-related quality of life (EQ-5D-5L index) (R2 = 0.43, p < 0.001), in which visual acuity (logMAR) (p < 0.001), anxiety (HADS-A) (p = 0.007), and age of diagnosis (p = 0.04)  were independently associated with health-related quality of life (EQ-5D-5L). The moderation model for anxiety (R2 = 0.47, F = 5.91, p < 0.001) revealed a significant interaction of visual acuity and levels of anxiety in relation to health-related quality of life. Conditional effects analysis suggested that higher logMAR values (which indicate more vision loss) were associated with lower EQ-5D-5L index (indicating worse health-related quality of life), this relationship being stronger (even more negative), when levels of anxiety are high. Clinical and rehabilitation services providing care for chronic eye disease patients should include regular checks for patients' levels of anxiety, even in patients who still have preserved visual acuity, to help preventing a synergistic source of long-term poor quality of life and disability.

Is perceived social support more important than visual acuity for clinical depression and anxiety in patients with age-related macular degeneration and diabetic retinopathy?

OBJECTIVE: To investigate whether visual acuity has the same importance as a factor of depression and anxiety comparing with other psychological variables, particularly perceived social support, in patients diagnosed with age-related eye diseases, with and without low vision. DESIGN: Observational cross-sectional study. SETTING: Patients attending outpatient appointments at the department of ophthalmology of a general hospital in Portugal. SUBJECTS: Patients with age-related macular degeneration and patients with diabetic retinopathy attending routine hospital appointments were recruited for this study. MEASURES: Anxiety and depression were measured using the hospital anxiety and depression scale and perceived social support using the multidimensional scale of perceived social support. Visual acuity was measured with ETDRS charts. RESULTS: Of the 71 patients, 53 (75%) were diagnosed with diabetic retinopathy, 37 (52%) were female and age (mean ± SD) was 69 ± 12 years. Acuity in the better seeing eye was 0.41 ± 0.33 logMAR. The mean anxiety score was 4.38 ± 3.82 and depression 4.41 ± 3.39. Clinically significant levels of anxiety were found in 21% (n = 15) of the participants and depression in 18%(n = 13). The total social support score was 5.29 ± 0.61. Significant multivariate regression models were found for anxiety (R2 = 0.21, P = 0.016) and for depression (R2 = 0.32, P < 0.0001). Social support was independently associated with levels of anxiety and with levels of depression. Gender was independently associated with levels of anxiety. CONCLUSION: This study suggests that patients' perceived social support might be more important than visual acuity as a factor of clinical depression and anxiety in a sample of age-related eye disease patients.

Cost-effectiveness of basic vision rehabilitation (The basic VRS-effect study): study protocol for a randomised controlled trial.

PURPOSE: To investigate the cost-effectiveness of a basic vision rehabilitation service (basic-VRS) in Portugal. We designed a parallel group, randomised controlled trial whose aim is to compare the effects and costs of 'usual low vision care' with a 'basic-VRS intervention' on self-reported visual ability and other psychosocial and health-related quality-of-life outcomes. METHODS: The trial will recruit participants that meet the following inclusion criteria: (1) visual acuity between 0.4-1.0 logMAR in the better-seeing eye, (2) cause of vision loss is diabetic retinopathy or age-related macular degeneration, (3) 18 years or older and iv) live in the community (not in nursing homes or other type of institution). Participants will be randomised to one of the study arms consisting of immediate intervention and delayed intervention. The delayed intervention group will receive 'usual care' or no intervention in the first 12 weeks. Visual acuity, contrast sensitivity and retinal structure will be assessed during the study. RESULTS: The primary outcome measure is visual ability, which will be evaluated with the Massof Activity Inventory, we expect that the intervention will raise the overall person measure or visual ability. Reading, health-related quality-of-life, anxiety and depression and social support will be also assessed. The analysis will be undertaken on an intention-to-treat basis. A cost-effectiveness analysis will be performed to provide information about the cost per unit of utility. To evaluate the cost-effectiveness of the intervention we will adopt the perspective of the healthcare system. CONCLUSION: This study will provide additional evidence about the effects of basic-VRS on self-reported visual ability. Findings from this study should also contribute to better planning of low vision provision and, consequently, may contribute to reduce barriers to basic-VRS.

The Portuguese Experience with Ocriplasmin in Clinical Practice.

AIM: Evaluate the real-life experience with ocriplasmin on vitreomacular traction (VMT) release and full-thickness macular hole (FTMH) closure in Portugal. METHODS: Multicentric, retrospective study of 83 eyes of 78 patients who were treated with intravitreal ocriplasmin for VMT with and without FTMH. Primary outcomes were VMT release and FTMH closure. Secondary outcomes included visual acuity changes and structural features on spectral-domain ocular coherence tomography. RESULTS: VMT resolved in 47 of the 83 eyes (56.6%) and 6 of the 12 FTMH were closed (50.0%). Mean best-corrected visual acuity (BCVA) improved from 65.1 at baseline to 70.8 ETDRS letters at the end of follow-up (p < 0.0001) with a mean follow-up of 138.8 days. Improvement in BCVA was significantly better in eyes with VMT release (p = 0.021). Approximately 73% of patients had normal ellipsoid zone integrity at the end of follow-up, 87% had no neurosensorial detachment and 40% had no intra- or subretinal fluid. CONCLUSION: VMT release and FTMH closure were achieved in more than half of the treated eyes and were correlated with significant BCVA improvements and favorable baseline characteristics. In fact, if a careful patient selection is carried out, VMT resolution with ocriplasmin can be optimized, tailoring the best approach to each patient.

La enfermedad meningocóccica en el primer mes de la vida / Meningococcal disease in the first month of the life

Se estudiaron 14 de los 17 niños de 0 a 30 días de edad, que recibieron el diagnóstico de enfermedad meningocóccica en los hospitales pediátricos de Ciudad de la Habana, durante un período de 24 meses, de los cuales 10 egresaron vivos y 4 fallecieron. Uno presentó la enfermedad a la edad de 24 horas y otro en la primera semana de vidad, por lo que se consideró como forma congénita a partir de los genitales maternos. Los resultados (todos mayores de 14 días) tuvieron la forma la forma adquirida por el tracto respiratorio. El cuadro clínico al ingreso se expresó por fiebre, manifestaciones respiratorias y neurológicas, así como digestivas a veces. La oligoanuria, esplenomegalia, frialdad, taqui o bradicardia, sangramiento y midriasis fueron más frecuentes en pacientes de evolución fatal. Los recuentos leucocitario y palquetario con frecuencia permanecieron normales al comienzo de la enfermedad, así como la eritrosedimentación. Las complicaciones a veces se presentaron en un período posterior al que lo hacen otros niños en edades mayores (AU)

La enfermedad meningocóccica en el primer mes de la vida / Meningococcal disease in the first month of the life

Se estudiaron 14 de los 17 niños de 0 a 30 días de edad, que recibieron el diagnóstico de enfermedad meningocóccica en los hospitales pediátricos de Ciudad de la Habana, durante un período de 24 meses, de los cuales 10 egresaron vivos y 4 fallecieron. Uno presentó la enfermedad a la edad de 24 horas y otro en la primera semana de vidad, por lo que se consideró como forma congénita a partir de los genitales maternos. Los resultados (todos mayores de 14 días) tuvieron la forma la forma adquirida por el tracto respiratorio. El cuadro clínico al ingreso se expresó por fiebre, manifestaciones respiratorias y neurológicas, así como digestivas a veces. La oligoanuria, esplenomegalia, frialdad, taqui o bradicardia, sangramiento y midriasis fueron más frecuentes en pacientes de evolución fatal. Los recuentos leucocitario y palquetario con frecuencia permanecieron normales al comienzo de la enfermedad, así como la eritrosedimentación. Las complicaciones a veces se presentaron en un período posterior al que lo hacen otros niños en edades mayores