Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 587
Filtrar
1.
Surv Ophthalmol ; 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32057763

RESUMO

Ocular trauma is a significant cause of blindness worldwide, particularly if is associated with glaucoma. Direct damage from blunt or penetrating trauma, bleeding, inflammation, lens-related problems, orbital and brain vascular pathologies related to trauma, and chemical injuries may increase intraocular pressure and lead to traumatic glaucoma. Treatment may be as simple as eliminating the underlying cause in some conditions, or management can be challenging, depending on the mechanism of damage. If proper management is not undertaken, visual outcomes can be poor. We discuss a broad spectrum of trauma-related mechanisms of intraocular pressure elevation, as well as their management.

2.
Eur J Prev Cardiol ; : 2047487320905024, 2020 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-32070132
3.
J Hum Hypertens ; 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32042073

RESUMO

Isometric handgrip exercise (IHG) triggers acute increases in cardiac output to meet the metabolic demands of the active skeletal muscle. An abnormal cardiovascular response to IHG might reflect early stages of cardiovascular disease. In a large community-based cohort, we comprehensively assessed the clinical correlates of acute cardiovascular changes during IHG. In total, 333 randomly recruited subjects (mean age, 53 ± 13 years, 45% women) underwent simultaneous echocardiography and finger applanation tonometry at rest and during 3 min of IHG at 40% maximal handgrip force. We calculated time-domain measures of short-term heart rate variability (HRV) from finger pulse intervals. We assessed the adjusted associations of changes in blood pressure (BP) and echocardiographic indexes with clinical characteristics and HRV measures. During IHG, men presented a stronger absolute increase in heart rate, diastolic BP, left ventricular (LV) volumes and cardiac output than women, even after adjustment for covariables. In adjusted continuous and categorical analyses, age correlated positively with the increase in systolic BP and pulse pressure, but negatively with the increase in LV stroke volume and cardiac output during exercise. After full adjustment, a greater increase in systolic and diastolic BP during exercise was associated with lower absolute real variability (P ≤ 0.026) and root mean square of successive differences (P ≤ 0.032) in pulse intervals at rest. In a general population sample, women presented a weaker cardiovascular response to IHG than men. Older age was associated with greater rise in BP pulsatility and diminished cardiac reserve. Low HRV at rest predicted a higher BP increase during isometric exercise.

4.
Cancer Causes Control ; 31(2): 153-159, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31894492

RESUMO

PURPOSE: Survival benefits could be potentially improved by adding cardiorespiratory fitness (CRF) to lung cancer screening. The current pilot study aimed to assess the association between CRF and adverse outcomes in current male smokers who are meeting the American Cancer Society (ACS) criteria for lung cancer screening. METHODS: A total of 260 men with a baseline CRF assessment (treadmill exercise test) who are met the ACS lung cancer screening criteria ("current smokers aged 55-74 years with ≥ 30 pack/years smoking history") were prospectively studied. Cox proportional hazard models were analyzed for all-cause and cancer mortality, total and lung cancer incidence. RESULTS: Mean age was 63.3 ± 5.4 years, smoking history 50.4 ± 26.7 pack/years, and CRF was 7.8 ± 3.2 metabolic equivalents (METs). During a mean of 10.2 ± 6.1 years follow-up, 80 participants developed any type of cancer, 19 were diagnosed with lung cancer and 66 died (cancer, n = 39, other causes, n = 27). In multivariable models, only CRF was associated with all-cause and cancer mortality. Each 1-MET higher CRF was associated with a 10% reduced risk for all-cause mortality [0.9, 95% CI (0.83 to 0.98), p = 0.017] and cancer mortality [0.9, 95% CI (0.8 to 0.99), p = 0.048]. CRF was not associated with total cancer incidence (p = 0.59) or lung cancer incidence (p = 0.96). CONCLUSION: Higher CRF is independently associated with lower risk of all-cause and cancer mortality in current male smokers who meet the ACS criteria for lung cancer screening. Screening for CRF and achieving higher CRF levels could potentially reduce mortality and serve as complementary preventive strategy in heavy smokers.

5.
JAMA Ophthalmol ; 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31895454

RESUMO

Importance: Although the central visual field (VF) in end-stage glaucoma may substantially vary among patients, structure-function studies and quality-of-life assessments are impeded by the lack of appropriate characterization of end-stage VF loss. Objective: To provide a quantitative characterization and classification of central VF loss in end-stage glaucoma. Design, Setting, and Participants: This retrospective cohort study collected data from 5 US glaucoma services from June 1, 1999, through October 1, 2014. A total of 2912 reliable 10-2 VFs of 1103 eyes from 1010 patients measured after end-stage 24-2 VFs with a mean deviation (MD) of -22 dB or less were included in the analysis. Data were analyzed from March 28, 2018, through May 23, 2019. Main Outcomes and Measures: Central VF patterns were determined by an artificial intelligence algorithm termed archetypal analysis. Longitudinal analyses were performed to investigate whether the development of central VF defect mostly affects specific vulnerability zones. Results: Among the 1103 patients with the most recent VFs, mean (SD) age was 70.4 (14.3) years; mean (SD) 10-2 MD, -21.5 (5.6) dB. Fourteen central VF patterns were determined, including the most common temporal sparing patterns (304 [27.5%]), followed by mostly nasal loss (280 [25.4%]), hemifield loss (169 [15.3%]), central island (120 [10.9%]), total loss (91 [8.3%]), nearly intact field (56 [5.1%]), inferonasal quadrant sparing (42 [3.8%]), and nearly total loss (41 [3.7%]). Location-specific median total deviation analyses partitioned the central VF into a more vulnerable superonasal zone and a less vulnerable inferotemporal zone. At 1-year and 2-year follow-up, new defects mostly occurred in the more vulnerable zone. Initial encroachments on an intact central VF at follow-up were more likely to be from nasal loss (11 [18.4%]; P < .001). One of the nasal loss patterns had a substantial chance at 2-year follow-up (8 [11.0%]; P = .004) to shift to total loss, whereas others did not. Conclusions and Relevance: In this study, central VF loss in end-stage glaucoma was found to exhibit characteristic patterns that might be associated with different subtypes. Initial central VF loss is likely to be nasal loss, and 1 specific type of nasal loss is likely to develop into total loss.

6.
J Cardiopulm Rehabil Prev ; 40(1): 17-23, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31192806

RESUMO

PURPOSE: High-intensity interval training (HIIT) has been observed to improve health and fitness in patients with cardiovascular disease. High-intensity interval training may not be appropriate in community-based settings. Moderate-intensity interval training (MIIT) and resistance training (RT) are emerging as effective alternatives to HIIT. These have not been well investigated in a community-based cardiac maintenance program. METHODS: Patients with coronary artery disease and/or diabetes mellitus participated in clinical examinations and a 6-mo exercise program. Center-based MIIT and home-based moderate continuous intensity exercise were performed for 3-5 d/wk for 30-40 min/session. RT, nutritional counseling, coping, and behavioral change strategies were offered to all patients. Within-group changes in clinical metrics and exercise performance were assessed on a per-protocol basis after 6 mo. RESULTS: Two hundred ninety-two patients (74%) concluded the 6-mo program. There were no serious adverse events. The peak oxygen uptake and peak workload increased significantly, 21.8 ± 6.1 to 22.8 ± 6.3 mL/kg/min and 128 ± 39 to 138 ± 43 W, respectively (both P < .001). Submaximal exercise performance increased from 68 ± 19 to 73 ± 22 W (P < .001). Glycated hemoglobin decreased from 6.57 ± 0.93% to 6.43 ± 0.12%, (P = .023). Daily injected insulin dosage was reduced from 42 IU (interquartile range: 19.0, 60.0) to 26 IU (interquartile range: 0, 40.3, P < .001). CONCLUSIONS: MIIT and RT were feasible and effective in a community-based cardiac maintenance program for patients with cardiovascular disease, improving exercise performance, and blood glucose control.

7.
Int J Cardiol ; 301: 180-182, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31757647

RESUMO

INTRODUCTION: Cardiopulmonary exercise testing (CPX) is the gold-standard approach to assessing cardiorespiratory fitness (CRF). The current study puts forth reference standards for peak oxygen (O2) pulse from the "Fitness Registry and the Importance of Exercise: A National Data Base" (FRIEND) Registry. METHODS: The current analysis included 13,318 tests from CPX laboratories in the United States, Canada and Europe. Inclusion criteria included CPX data on apparently healthy men and women: 1) aged ≥20 years; 2) with exercise tests performed on a treadmill; and 3) achieving a peak respiratory exchange ratio ≥ 1.00. RESULTS: Peak O2 pulse 50th percentile values decreased from 20.8 ml/beat in the 2nd decade to 11.2 ml/beat in the 8th decade in men and from 13.6 ml/beat in the 2nd decade to 7.9 ml/beat in the 8th decade in women. Linear regression analysis results produced the following statistically significant (p < 0.001) equation: peak O2 pulse (ml/beat) = 23.2-0.09(age) - 6.6(sex); female = 1 and male = 0. DISCUSSION: The assessment of CRF through CPX is an important health metric. Reference standards, such as those put forth in the current study, allow for the comparison of key measures of CRF to expected normal responses across the adult lifespan.

8.
Expert Opin Pharmacother ; 21(1): 39-45, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31663782

RESUMO

Introduction: Reduction of intraocular pressure (IOP) is the only known modifiable risk factor for prevention and treatment of glaucoma. Rho-kinase (ROCK) inhibitors are a new class of glaucoma medications introduced recently with novel mechanisms of action and favorable safety profiles. Latanoprost, a common first line drug used for treatment of glaucoma, does not adequately control pressures in all cases. Addition of more than one anti-glaucoma medication affects patient compliance and adherence. Fixed-combination eye drops are combinations of two or more active drugs in a single dosage form, thus simplify dosing. New to this group is the fixed combination netarsudil- latanoprost (FCNL).Area covered: This review focuses on FCNL, its pharmacodynamics and pharmacokinetics. It also details the efficacy and safety of individual drugs compared to FCNL.Expert opinion: The combination of latanoprost and netarsudil is a potent medication and modulates all known targets for IOP reduction in a single drop and has been shown to be more effective than either drug alone. FCNL is an alternative for those with inadequately controlled IOP on a prostaglandin analog alone, as well as those for whom a simplified regimen is desirable, or those who are not good candidates for other classes of glaucoma medications.

9.
J Glaucoma ; 29(1): 31-38, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31688371

RESUMO

PURPOSE: The purpose of this study was to assess the relationship between the rate of the glaucomatous visual field (VF) worsening and baseline age and baseline VF mean deviation (MD). DESIGN: This study was a retrospective, multisite cohort. PARTICIPANTS: A total of 84,711 reliable Swedish Interactive Thresholding Algorithm 24-2 VF tests from 8167 eyes from 5644 patients with ≥6 VF tests, ≥5 years of follow-up, baseline age 18 years or above and baseline MD ≥-10 dB, and at least 2 abnormal VF tests were included from the Glaucoma Research Network Database. METHODS: The global mean deviation rates (MDRs) and pointwise total deviation rates (TDRs) of VF progression (dB/y) were calculated for each eye using linear regression. The relationships between MDR and baseline age and MD were determined using linear mixed-effects models and logistic regression, with rapid progression defined as an MDR≤-1.0 dB/y. The relationships between TDR and baseline age and baseline MD were determined using linear mixed-effects models. MAIN OUTCOME MEASURES: Coefficients of the regression models. RESULTS: In individual mixed-effects models both baseline age (ß=-0.0079 dB/y; P<0.001) and baseline MD (ß=0.012/y; P<0.001) were associated with faster progression. All parameters were statistically significant in the full model with both parameters and their interaction (ß=0.00065; P=0.0017) as covariates. With logistic regression, each year increase in baseline age increased the odds of belonging to the rapid-progressing group by a factor of 1.033, and each unit increase in baseline MD (less severe visual loss) decreased the odds by a factor of 0.8821. The mean pointwise TDR ranged from -0.21 to -0.55 dB/y, with the most rapid pointwise progression observed in the nasal and paracentral regions of the field. CONCLUSIONS: Older age and worse MD at baseline are associated with more rapid VF progression in this large dataset. The effect of age on MDR is influenced by baseline MD severity, supporting the importance of early detection and more aggressive therapy in older patients with worse VF damage. The pointwise rate of VF loss varies across the VF, providing a means for physicians to more effectively monitor progression.

10.
Mayo Clin Proc ; 95(2): 255-264, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31883698

RESUMO

OBJECTIVE: To begin the process of developing global reference standards for adults from directly measured cardiorespiratory fitness (CRF). METHODS: Percentiles of maximal oxygen consumption (VO2max) for men and women were determined for each decade from 20 through 79 years of age using International data from the Fitness Registry and Importance of Exercise: A National Database (FRIEND-I) along with previously published data from seven studies. FRIEND-I data from January 1, 2014, through January 1, 2019, included 11,678 maximal treadmill tests from three countries, whereas the previously published reports included 32,329 maximal treadmill tests from six countries. RESULTS: FRIEND-I data revealed significant differences between sex and age groups for VO2max (P<0.01). For the 20- to 29-years of age group, the 50th percentile VO2max in men and women were 49.5 mLO2⋅kg-1⋅min-1 and 40.6 mLO2⋅kg-1⋅min-1, respectively. VO2max declined an average of 9% per decade with the 50th percentile for the 70- to 79-years of age group having a VO2max of 30.8 mLO2⋅kg-1⋅min-1 in men and 25.0 mLO2⋅kg-1⋅min-1 in women. These results were similar in magnitude and direction to the previously published literature. Within both the FRIEND-I and previously published data there were CRF differences between countries. CONCLUSION: This report begins to establish global reference standards for CRF. Continued development of FRIEND-I will increase global representation providing an improved ability to identify and stratify CRF risk categories.

11.
Chest ; 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31794701

RESUMO

BACKGROUND: Established reference standards for the ventilatory threshold (Vt) are lacking. The aim of this study was to develop reference standards for the Vt derived from cardiopulmonary exercise testing (CPX) using treadmill and cycle ergometry. METHODS: Seven laboratories experienced in CPX administration with established quality control procedures contributed to the Fitness Registry and the Importance of Exercise: A National Database (FRIEND) from April 2014 through February 2019. Vt data from 27 states in the United States and the Ontario Province in Canada, comprising 9,350 tests (treadmill: n = 1,195; cycle ergometer: n = 8,155) in men (n = 7,540) and women (n = 1,810) 20 to 79 years of age who were free from smoking and known cardiovascular, pulmonary, metabolic, and/or neoplastic disease were used to develop the reference standards. Comparisons of Vt values were made between exercise testing modes, sex, and age groups. RESULTS: Vt values on the treadmill were higher than cycle ergometry; men had higher Vt values than women on both test modalities, and the highest Vt values achieved were in the 20- to 29-year-old age group compared with all other age groups (all P < .001). The rates of decline in Vt values from age groups 20 to 29 through 70 to 79 years of age were 23% and 35% in men and 47% and 30% in women for treadmill and cycle ergometry tests, respectively. CONCLUSIONS: In addition to previous reference standards from FRIEND for cardiorespiratory fitness, the Vt reference standards reported herein provide valuable information on functional metric. These data have important implications for CPX interpretation and aerobic exercise prescription in the clinical and fitness settings.

15.
Can J Ophthalmol ; 54(6): 717-722, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31836105

RESUMO

OBJECTIVES: To determine ocular outcomes and factors associated with adherence to ophthalmic follow-up in a medically underserved population at a single health centre in Philadelphia. DESIGN: Retrospective chart review. PARTICIPANTS: Patients from a community glaucoma screening program. METHODS: Chart review was conducted for participants who received a complete eye examination at the Philadelphia District Health Center 5 between January 1, 2012 and May 31, 2014 within the Philadelphia Glaucoma Detection and Treatment Project. Multivariate logistic regression was used to determine factors related to ophthalmic follow-up adherence. RESULTS: A total of 249 participants completed an eye examination (mean age = 57.7 ± 6.9 years). Most were African American (n = 220; 88.4%); female (n = 129; 51.8%). Forty-seven participants (18.9%) received glaucoma-related diagnoses, 20 (8.0%) were prescribed ocular medication, and 26 (10.4%) underwent laser therapy. Ninety (36.1%) attended their recommended follow-up eye examination at the health centre. Glaucoma-related diagnosis (p ≤ 0.001), recommendation of a 4- to 6-week follow-up period (p < 0.001), prescribed eye drops (p < 0.001), or received laser therapy (p = 0.047) were factors most predictive of ophthalmic follow-up adherence. CONCLUSIONS: The collaborative effort of eye care providers and health centres offers an important opportunity to detect, treat, and manage glaucoma and other ocular pathology in medically underserved communities. Having a glaucoma-related diagnosis, initiating treatment, and scheduling regular follow-up visits are the most important factors influencing adherence to follow-up eye appointments.

16.
J Cataract Refract Surg ; 45(12): 1704-1710, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31856979

RESUMO

PURPOSE: To determine the efficacy, safety, and surgical outcomes of trabecular microbypass stent (iStent) surgery performed by resident trainees and attending surgeons. SETTING: Wills Eye Hospital, Philadelphia, Pennsylvania, USA. DESIGN: Retrospective case series. METHODS: Records of all patients who had microbypass stent surgery by a resident at Wills Eye Hospital were retrospectively reviewed. The attending-performed group included any patient who had a microbypass stent implanted by an attending surgeon on the same day a resident case was performed. RESULTS: Between 2016 and 2018, 31 microbypass stents were implanted by a resident supervised by an attending and 93 microbypass stents were implanted by an attending surgeon on the day a resident case was performed. The mean follow-up was 16.2 months ± 17.9 (SD). The mean intraocular pressure (IOP) decreased from 16.0 ± 4.6 mm Hg at baseline to 14.0 ± 3.1 mm Hg at most recent follow-up visit in the resident group (P = .02) and from 17.5 ± 4.8 mm Hg to 15.1 ± 4.3 mm Hg, respectively, in the attending group (P < .001). The final mean IOP and mean number of hypotensive medications were similar between the 2 groups (P = .83 and P = .12, respectively). Self-resolving hyphema occurred in 1 resident case and 2 attending cases. The resident group had 1 case of iridodialysis, which did not require additional surgery. One eye in the attending group ultimately required a trabeculectomy. CONCLUSION: Microbypass stent implantation by resident trainees with attending supervision had similar efficacy and safety as surgery performed by attending surgeons.

17.
J Glaucoma ; 2019 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-31876876

RESUMO

PRéCIS:: A modification to the surgical technique of Ahmed glaucoma valve implantation without plate sutures or surgical glue products has a similar safety and efficacy profile than the standard procedure, in the short and mid-term follow-up. PURPOSE: To assess the safety and efficacy of a modified Ahmed glaucoma valve (AGV) implantation technique without plate sutures. METHODS: Retrospective case-control study including patients seen in the Glaucoma service of an academic institution. Patients that underwent a modified AGV implantation without plate sutures were included as cases and patients that underwent standard AGV implantation, as controls. Success was defined as intraocular pressure (IOP) reduction >20%, IOP >5 and <21 without need for additional surgical intervention, and maintenance of light perception. RESULTS: 170 eyes were included. Mean (range) follow-up was 11.2±7.39 (3-24) months. There was no statistically significant difference in visual acuity and IOP between the groups during the post-operative period. In a univariate analysis, there was a larger decrease in IOP for the no plate suture group at the 6 months (-15.6±11.6 vs. -11.5±10.5, P=0.04) and 1 year (-16.4±10.4 vs. -11.1±10.4, P=0.02) visits. There was also a larger decrease in number of medications in the no plate suture group in the 3 months (-1.65±1.5 vs. -1.13±1.22, P=0.02), 6 months (-1.55±1.44 vs. -0.98±1.3, P=0.01) and 1 year (-1.70±1.5 vs. -1.04±1.2, P=0.04) visits. However, those differences were not confirmed by a multivariable model after adjusting for glaucoma type and number of previous glaucoma surgeries. No differences in the trajectory of the survival curves were noted between groups (P=0.36). CONCLUSION: The comparison of short and mid-term outcomes of patients undergoing AGV implantation using both techniques showed similar outcomes and success rates.

18.
Prog Cardiovasc Dis ; 2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31759954

RESUMO

New improved reference equations for cardiorespiratory fitness have recently been published, using Data from the Fitness Registry and the Importance of Exercise National Database (FRIEND Registry). The new linear equation for VO2max (ml.kg-1.min-1) was additive, derived using multiple-linear regression. An alternative multiplicative allometric model has also been published recently, thought to improve further the quality of fit. The purpose of the current study was to compare the accuracy and quality/goodness-of-fit of the linear, additive model with the multiplicative allometric model using the FRIEND database. The results identified that the allometric model out performs the linear model based on all model-comparison criteria. The allometric model demonstrates; 1) greater explained variance (R2 = 0.645; R = 0.803) vs. (R2 = 0.62; R = 0.79), 2) residuals that were more normally distributed, 3) residuals that yielded less evidence of curvature, 4) superior goodness-of-fit statistics i.e., greater maximum log-likelihood (MLL) and smaller Akaike Information Criterion (AIC) statistics, 5) less systematic bias together with smaller unexplained standard error of estimates. The Bland and Altman plots also confirmed little or no evidence of curvature with the allometric model, but systematic curvature (lack-of-fit) in the linear model. The multiplicative allometric model to predict VO2max was; VO2max (ml.kg-1.min-1) = M-0.854 · H1.44 · exp. (0.424-0.346 · (sex) -0.011.age), where M = body mass and H = height (R2 = 0.645; R = 0.803) and sex is entered as a [0,1] indicator variable (male = 0 and female = 1). Another new insight obtained from the allometric model (providing construct validity) is that the height-to-body-mass ratio is similar to inverse body mass index or the lean body mass index, both associated with leanness when predicting VO2max. In conclusion adopting allometric models will provide more accurate predictions of VO2max (ml.kg-1.min-1) using more plausible, biologically sound and interpretable models.

19.
J Phys Act Health ; 16(12): 1098-1104, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31751934

RESUMO

BACKGROUND: To assess the joint and stratified associations between cardiorespiratory fitness (CRF), incidence, and mortality from cancer in never, former, and current male smokers. METHODS: CRF (treadmill exercise test) was assessed in 4694 men (never smokers [n = 1715]; former smokers [n = 1602], 32.4 [30.5] pack-years; and current smokers [n = 1377], 40.3 [26] pack-years) aged 58.1 (17.3) years, and prospectively followed for 12.7 (7.5) years. Multivariable Cox hazard models were analyzed. RESULTS: In joint analyses, where high CRF in never smokers was used as a reference, hazard ratios and 95% (confidence intervals) for cancer incidence and cancer mortality were as follows: moderate CRF 1.41 (1.0-1.9) and 3.0 (1.7-5.5) in never smokers, 1.65 (1.3-2.2) and 3.7 (2.1-6.6) in former smokers, and 1.3 (0.9-1.7) and 3.4 (1.9-6.1) in current smokers, respectively. The corresponding values for low CRF were 1.53 (1.1-2.2) and 5.1 (2.7-9.5), 1.84 (1.3-2.5) and 6.6 (3.7-11.8), and 1.5 (1.1-2.2) and 5 (2.7-9.3), respectively. In stratified analyses by smoking status, compared with low CRF, moderate and high CRF were associated with a 32% to 78% reduction in cancer mortality risk (P trend for all <.001). CONCLUSION: Higher CRF is associated with lower risk of incidence and mortality from cancer regardless of smoking status, supporting the potential preventive benefits for public health.

20.
Telemed J E Health ; 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31721654

RESUMO

Background: Cataracts are a major cause of visual impairment and blindness in the United States and worldwide. Introduction: Risk factors for cataracts include age over 40 years, smoking, diabetes, low socioeconomic status, female sex, steroid use, ocular trauma, genetic factors, and exposure to ultraviolet-B light. Community-based telemedicine vision screenings can be an efficient method for detecting cataracts in underserved populations. The Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study reports the prevalence and risk factors for cataracts in individuals screened and examined for glaucoma and other eye diseases. Materials and Methods: A total of 906 high-risk individuals were screened for glaucoma using telemedicine in seven primary care practices and four Federally Qualified Health Centers in Philadelphia. Participants with suspicious nerves or other abnormalities on fundus photographs, unreadable images, and ocular hypertension returned for an eye examination with an ophthalmologist at the same community location. Results: Of the participants screened through telemedicine, 347 (38.3%) completed a follow-up eye examination by an ophthalmologist. Of these, 267 (76.9%) were diagnosed with cataracts, of which 38 (14.2%) had visually significant cataracts. Participants who were diagnosed with visually significant cataract were more likely to be older (p < 0.001), have diabetes (p = 0.003), and worse visual acuity (p < 0.001). Discussion: Our study successfully detected and confirmed cataracts in a targeted, underserved urban population at high risk for eye disease. Conclusions: Telemedicine programs offer an opportunity to identify and refer individuals who would benefit from continuous follow-up eye care and treatment to improve visual function and quality of life.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA