The effect of multimedia interventions on the informed consent process for cataract surgery in rural South India.

CONTEXT: The provision of ocular surgical interventions for poorer, less educated populations is increasing as a result of increased globalization and outreach. However, these populations still have trouble understanding surgical concepts and are not always fully informed decision makers. AIMS: We aimed to test the effect that a multimedia addition to a traditional verbal informed consent would have on patient comprehension of relatively difficult cataract surgical concepts. SETTINGS AND DESIGN: We conducted a randomized controlled trial with relatively uneducated patients reporting to a private surgical hospital in Chennai, India. 47 patients were placed into the intervention group and 50 patients were placed into the control group. MATERIALS AND METHODS: The intervention group was presented with a scripted verbal informed consent as well as a 3-fold pamphlet and a presentation with a 3-dimensional model of the eye. The control group was only presented with a scripted verbal informed consent. The two groups were tested using an 11 item "True/False/I don't know" quiz directly before the informed consent, directly after the informed consent, and one-day postoperatively. STATISTICAL ANALYSIS USED: Scores on the quiz were compared across groups and time-points using paired t-tests. RESULTS: Patients in the both groups showed a significant improvement in scores between pre- and post-informed consent quizzes (P value on the order of 10(-6)) and the improvement in scores was significantly greater in the intervention group than the control group (P value on the order of 10(-16)). There was no significant difference observed in either group with regards to the change in scores between post-informed consent and post-operative quizzes. CONCLUSION: Multimedia aids in addition to a standard informed consent process are effective in improving patient comprehension even for patients with low literacy and limited knowledge of surgical interventions.

Evaluation of adverse events in self-reported sulfa-allergic patients using topical carbonic anhydrase inhibitors.

PURPOSE: To investigate whether a self-reported history of allergy to sulfa-based drugs is a predictor for subsequent adverse reactions to topical carbonic anhydrase inhibitors (CAIs). METHODS: A retrospective case-controlled cohort study via chart review was performed on 1,287 patients with a diagnosis of glaucoma. The outcome measure was the development of an adverse reaction (either ocular, systemic, or both) within at least 30 days after receipt of 1 of 4 classes of topical glaucoma medications: CAIs (dorzolamide and brinzolamide), prostaglandin analogues, beta-adrenergic blockers, and alpha2-adrenergic agonists. RESULTS: Patients with a self-reported history of sulfa allergy had significantly more ocular adverse reactions after the initiation of any of the topical antiglaucoma medications when compared to those patients with no reported allergies. Patients with a self-reported sulfa allergy and patients who self-reported other, nonsulfa-related allergies had similar rates of adverse reactions to most of the topical medications. The patients reporting a sulfa allergy who used topical CAIs did not have more adverse reactions compared with patients who reported having other, nonsulfa-related allergies who used topical CAIs. Self-reported sulfa-allergic patients had similar rates of adverse reactions to topical CAIs compared with topical prostaglandin analogues. CONCLUSION: It may be safe to use a topical CAI in patients who report a history of a sulfa allergy. Patients with medication allergies of any kind may be more likely to develop allergic reactions to other, unrelated drug classes.

Protective eyewear use as depicted in children's television programs.

PURPOSE: To characterize the depiction of protective eyewear use in scripted children's television programs. METHODS: Viewership ratings data were acquired to generate a list of the most-watched scripted broadcast and cable programs for the 2- to 12-year-old age group. The three highest average viewership programs from broadcast and cable programming that met the inclusion criteria were analyzed by two independent reviewers. RESULTS: Review of 30 episodes revealed a total of 244 exposure-scenes in which an individual was engaged in an activity requiring eye protection. There were 5.5 (mean = 8.1) exposure-scenes per episode, with 26 of 30 (87%) episodes containing at least one exposure-scene. There were 19 depictions of protective eyewear use (8% of total exposure-scenes). Fifteen of the 19 cases of protective eyewear use occurred on broadcast programming. Six eye injuries were depicted in the media content. CONCLUSION: The depiction of protective eyewear use during eye-risk activities is rare in scripted children's television programs and eye injuries are rarely depicted.

The depiction of protective eyewear use in popular television programs.

BACKGROUND: Media portrayal of health related activities may influence health related behaviors in adult and pediatric populations. This study characterizes the depiction of protective eyewear use in the scripted television programs most viewed by the age group that sustains the largest proportion of eye injuries. METHODS: Viewership ratings data were acquired to assemble a list of the 24 most-watched scripted network broadcast programs for the 13-year-old to 45-year-old age group. The six highest average viewership programs that met the exclusion criteria were selected for analysis. RESULTS: Review of 30 episodes revealed a total of 258 exposure scenes in which an individual was engaged in an activity requiring eye protection (mean, 8.3 exposure scenes per episode; median, 5 exposure scenes per episode). Overall, 66 (26%) of exposure scenes depicted the use of any eye protection, while only 32 (12%) of exposure scenes depicted the use of adequate eye protection. No incidences of eye injuries or infectious exposures were depicted within the exposure scenes in the study set. CONCLUSION: The depiction of adequate protective eyewear use during eye-risk activities is rare in network scripted broadcast programs. Healthcare professionals and health advocacy groups should continue to work to improve public education about eye injury risks and prevention; these efforts could include working with the television industry to improve the accuracy of the depiction of eye injuries and the proper protective eyewear used for prevention of injuries in scripted programming. Future studies are needed to examine the relationship between media depiction of eye protection use and viewer compliance rates.

The effect of a visual aid on the comprehension of cataract surgery in a rural, indigent South Indian population.

PURPOSE: To determine whether a visual aid improves the understanding and retention of information presented during informed consent for rural, indigent patients presenting for cataract surgery. MATERIALS AND METHODS: This was a randomized, unmasked, interventional study. We recruited patients who presented to the Hande Surgical Hospital in Chennai, India, for cataract surgery. Patients were randomized into two groups: verbal consent alone (group A) and verbal consent plus a poster (group B). Both groups completed an 11-question true/false quiz immediately before and after informed consent and one day after surgery. RESULTS: A total of 60 patients were recruited for the study, with 30 randomly assigned to each group; 23 patients from group A and 17 from group B completed the study. Informed consent improved patient scores in both groups; however, group B had significantly higher mean scores on postoperative day 1 (7.4 vs 8.7, P = 0.005) and significantly greater improvement in mean scores from pre-informed consent to postoperative day 1 (1.3 vs 3.6, P = 0.002). CONCLUSIONS: Informed consent improves patient understanding of cataract surgery. Using a visual aid during informed consent for cataract surgery improves understanding and retention of information more than verbal consent alone in a rural South Indian population.

Persistent ocular hypertension following intravitreal bevacizumab and ranibizumab injections.

PURPOSE: To study ocular hypertension (OHT) following intravitreal injections of bevacizumab and/or ranibizumab in patients with age-related macular degeneration (AMD). METHODS: Retrospective case series. Patients with AMD who were treated at a tertiary referral center with intravitreal bevacizumab and/or ranibizumab injections from January 1, 2006 to December 31, 2008 were studied. The development of OHT following these injections was investigated. RESULTS: Four out of 116 patients with AMD (3.45%) developed sustained elevated intraocular pressure (IOP) after multiple intravitreal injections of bevacizumab 1.5 mg/0.06 mL and/or ranibizumab 0.5 mg/0.05 mL. An analysis of 4 cases revealed: None of the patients had a previous diagnosis or family history of glaucoma/OHT. Two patients had both bevacizumab and ranibizumab injections. Two patients developed OHT after recent intravitreal ranibizumab and 2 patients after recent intravitreal bevacizumab injection. Two patients were pseudophakic with a history of YAG capsulotomy. The range of preinjection IOP was 8-15 mmHg (mean, 13 mmHg). The range of postinjection IOP was 28-36 mmHg (mean, 31.75 mmHg). The range of IOP increase was 17-21 mmHg (mean, 18.75 mmHg). Mean number of pan-anti-VEGF injections prior to OHT was 13.3 (range, 3-19). A disrupted posterior capsule might predispose patients to the development of OHT. CONCLUSIONS: Persistent OHT may occur after intravitreal anti-VEGF injection in patients with no previous diagnosis of glaucoma or OHT. OHT may persist across several visits and patients may require IOP-lowering therapy. Sustained elevation in IOP usually occurs after multiple injections.