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PURPOSE: To conduct a nationwide survey on the prevalence and causes of vision loss in Indigenous and non-Indigenous Australians. DESIGN: Nationwide, cross-sectional, population-based survey. PARTICIPANTS: Indigenous Australians aged 40 years or older and non-Indigenous Australians aged 50 years and older. METHODS: Multistage random-cluster sampling was used to select 3098 non-Indigenous Australians and 1738 Indigenous Australians from 30 sites across 5 remoteness strata (response rate of 71.5%). Sociodemographic and health data were collected using an interviewer-administered questionnaire. Trained examiners conducted standardized eye examinations, including visual acuity, perimetry, slit-lamp examination, intraocular pressure, and fundus photography. The prevalence and main causes of bilateral presenting vision loss (visual acuity <6/12 in the better eye) were determined, and risk factors were identified. MAIN OUTCOME MEASURES: Prevalence and main causes of vision loss. RESULTS: The overall prevalence of vision loss in Australia was 6.6% (95% confidence interval [CI], 5.4-7.8). The prevalence of vision loss was 11.2% (95% CI, 9.5-13.1) in Indigenous Australians and 6.5% (95% CI, 5.3-7.9) in non-Indigenous Australians. Vision loss was 2.8 times more prevalent in Indigenous Australians than in non-Indigenous Australians after age and gender adjustment (17.7%, 95% CI, 14.5-21.0 vs. 6.4%, 95% CI, 5.2-7.6, P < 0.001). In non-Indigenous Australians, the leading causes of vision loss were uncorrected refractive error (61.3%), cataract (13.2%), and age-related macular degeneration (10.3%). In Indigenous Australians, the leading causes of vision loss were uncorrected refractive error (60.8%), cataract (20.1%), and diabetic retinopathy (5.2%). In non-Indigenous Australians, increasing age (odds ratio [OR], 1.72 per decade) and having not had an eye examination within the past year (OR, 1.61) were risk factors for vision loss. Risk factors in Indigenous Australians included older age (OR, 1.61 per decade), remoteness (OR, 2.02), gender (OR, 0.60 for men), and diabetes in combination with never having had an eye examination (OR, 14.47). CONCLUSIONS: Vision loss is more prevalent in Indigenous Australians than in non-Indigenous Australians, highlighting that improvements in eye healthcare in Indigenous communities are required. The leading causes of vision loss were uncorrected refractive error and cataract, which are readily treatable. Other countries with Indigenous communities may benefit from conducting similar surveys of Indigenous and non-Indigenous populations.
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Cegueira/etnologia , Havaiano Nativo ou Outro Ilhéu do Pacífico/etnologia , Baixa Visão/etnologia , Pessoas com Deficiência Visual/estatística & dados numéricos , População Branca/etnologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Cegueira/etiologia , Análise por Conglomerados , Estudos Transversais , Técnicas de Diagnóstico Oftalmológico , Oftalmopatias/complicações , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Fatores de Risco , Baixa Visão/etiologia , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologiaRESUMO
Purpose: To evaluate the vision-related quality of life (VRQoL) of patients receiving hemodialysis through the assessment of the impact of vision impairment (IVI) questionnaire and ocular parameters, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), and refraction as calculated by spherical equivalent (SE) of each eye. Methods: Fifty-one patients with end-stage renal disease undergoing hemodialysis at a single center were recruited, and a total of 77 eyes were evaluated. BCVA, IOP, and SE were evaluated before and after hemodialysis (within 30 min). Results: Of the 51 patients recruited, 13 (25%) were female, 37 (73%) were male, and one (2%) chose not to specify gender. The mean age was 61.85 ± 32 years. The mobility IVI score was correlated significantly with the presence of hypertension (P = 0.01), eye drop usage (P = 0.04), and gender (P = 0.04). Emotional IVI scores were correlated significantly with diabetes (P = 0.03) and hypertension (P < 0.01). IOP significantly correlated with the IVI overall score (P = 0.02), including the reading IVI subscale and the emotional IVI subscale. Several factors were associated with posthemodialysis ocular parameters, including predialysis ocular parameters, age, and hypertension (P < 0.05 for all). Conclusions: IOP significantly correlated with VRQoL in hemodialysis patients. Demographic variables such as diabetes status, hypertension, eye drop usage, and gender also significantly correlated with subsections of the IVI questionnaire. This study investigated the relationship between ocular parameters and VRQoL in hemodialysis patients, and future longitudinal research is needed to further elucidate the mechanisms.
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AIM: To report the 6-month results of a clinical trial that compared intravitreous bevacizumab (BVB) 1.25 mg versus triamcinolone acetonide (TA) 4 mg when administered as an adjunct during cataract surgery to patients with diabetic macular oedema (DMO). METHODS: Prospective, double-masked, single-centre (Royal Victorian Eye and Ear Hospital, Melbourne) clinical trial. Patients with visually significant cataract and centre-involving DMO (either current or prior) were randomised (1: 1) to receive either intravitreous BVB 1.25 mg or TA 4 mg at the time of cataract surgery and if required at review. Main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline to the 6-month time point of this 12-month study. RESULTS: 61 eyes of 58 patients were enrolled. At baseline, both groups were similar in terms of BCVA and CMT (p>0.2). At 6 months, there was no significant difference in vision between the groups, with mean letter gain of +21.4 (95% CI +14.5 to +28.4) in the TA group and +17.3 (95% CI +12.1 to +22.6) in the BVB group (p=0.35). The TA group had a significant sustained anatomical improvement at 6 months, with a reduction in CMT (-51.4 µm; 95% CI -98.2 to -4.7) compared with thickening in the BVB group (+15.6 µm; 95% CI -26.4 to +57.7, p=0.04). CONCLUSIONS: When given as an adjunct to cataract surgery, both TA and BVB improved visual outcomes at 6 months postoperatively. However, only TA resulted in sustained improvement in CMT, with the majority not requiring any further treatment postoperatively.
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Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Extração de Catarata , Retinopatia Diabética/tratamento farmacológico , Glucocorticoides/uso terapêutico , Edema Macular/tratamento farmacológico , Triancinolona Acetonida/uso terapêutico , Idoso , Biometria , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/fisiopatologia , Método Duplo-Cego , Feminino , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Retina/fisiopatologia , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologiaRESUMO
Continuing professional development (CPD) is part of the medical education continuum, has been shown to produce improved physician practice and good patient outcomes, and is increasingly required for revalidation of medical licensure. CPD can be considered a discipline in its own right but is the least formally organized stage in medical education. CPD educators play a central role, but there has been remarkably little published work specifically describing CPD educators. This narrative review, using ophthalmology as exemplar medical specialty, describes trends affecting CPD educators and their sources, attributes, and development needs, mainly extrapolated from information regarding other medical educators in the medical education continuum spectrum. Future research needs are discussed.
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Educação Médica Continuada , Educadores em Saúde/normas , Oftalmologia/educação , Garantia da Qualidade dos Cuidados de Saúde , Competência Clínica/normas , Educadores em Saúde/organização & administração , HumanosRESUMO
PURPOSE: To investigate how quickly Goldmann applanation tonometers used in clinical practice develop calibration errors, and to determine the frequency of checks required to detect these errors. MATERIALS AND METHODS: Prospective check of the calibration error of all Haag-Streit Goldmann applanation tonometers in the department at month zero, month one, and month four. The tonometers were checked according to the Haag-Streit method using a standard calibration check weight bar by two independent observers. Calibration errors were classed as +/-0.5 to 2.5 mm Hg, +/-3 to 4 mm Hg, or >+/-4 mm Hg. Tonometers with a calibration error greater than +/-2.5 mm Hg were returned to the manufacturer for re-calibration. RESULTS: At month zero 2 of 34 (5.9%), at month one 3 of 29 (10.3%), and at month four 0 of 33 (0.0%) tonometers fell within the manufacturer's recommended calibration range of +/-0.5 mm Hg. A total of 14 of 34 (41.2%) tonometers at month zero, 10 of 29 (34.5%) tonometers at month one, and 17 of 33 (51.5%) tonometers at month four were identified to have calibration errors greater than +/-2.5 mm Hg. CONCLUSIONS: Goldmann applanation tonometers are not as accurate as the manufacturer's recommended calibration error tolerance of +/-0.5 mm Hg would suggest. Calibration error of less than +/-2.5 mm Hg is clinically acceptable. Calibration error checks should be carried out once monthly and tonometers with calibration error greater than +/-2.5 mm Hg returned to the manufacturer for re-calibration. Additional checks should be made if tonometers suffer specific damage. Ideally individual ophthalmologists should check calibration before each session.
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Calibragem/normas , Pressão Intraocular , Tonometria Ocular/normas , Humanos , Estudos Prospectivos , Controle de Qualidade , Reprodutibilidade dos Testes , Fatores de Tempo , Tonometria Ocular/instrumentaçãoRESUMO
PURPOSE: To assess the yearly incidence of vitrectomy for proliferative diabetic retinopathy (PDR) over an 11-year period, in a geographically defined part of North East England. The time period covered the introduction of diabetic retinopathy screening. METHODS: All patients undergoing vitrectomy for diabetic retinopathy in the Sunderland and South Tyneside area were recorded from 2000 to 2010. Incidence rates of vitrectomy specifically for the complications of PDR for the observed diabetic population, the estimated diabetic population and the population with known PDR were calculated. RESULTS: There was a gradual and significant decline in the vitrectomy rate from 157 (95% confidence interval, CI, 135-187) to 103 (95% CI 98-109) per 100,000 of the observed diabetic population in 2000 and 2010 respectively. The rate in the estimated diabetic population showed no significant change at 68 (95% CI 48-87) in 2002 and 77 (95% CI 55-103) in 2010. The rate in the PDR population, which comprised 2.4% of the known diabetic population in 2002 and 1.8% in 2010, declined significantly from 7.7% in 2002 to 5.7% in 2010. CONCLUSION: This study evaluated vitrectomy rates for PDR in an area of North East England. There were apparent declining rates of vitrectomy for PDR following the introduction of diabetic retinopathy screening but these have to be interpreted in the light of several confounding factors.
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Retinopatia Diabética/epidemiologia , Retinopatia Diabética/cirurgia , Vitrectomia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Retinopatia Diabética/sangue , Inglaterra/epidemiologia , Feminino , Geografia , Hemoglobinas Glicadas/metabolismo , Pesquisa sobre Serviços de Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
The exact incidence of submacular haemorrhage (SMH) in patients with neovascular age-related macular degeneration (nAMD) is unknown, and risk factors for its occurrence ill defined. It is known, however, to be a relatively common problem and important because the visual prognosis of these patients is poor. Unfortunately, patients with significant SMH were excluded from all the recent major randomised control trials for nAMD with antivascular endothelial growth factor (VEGF) agents and photodynamic therapy, and as such, the optimum management of patients is uncertain. SMH can present initially or during treatment of nAMD. The location, size, thickness and duration of SMH have an important bearing on treatment and outcomes. Thin or extrafoveal SMH are probably best treated with anti-VEGF agents alone. It has been proposed that patients with moderate-sized SMH, particularly thick haemorrhages, have an improved prognosis with surgical SMH displacement combined with treatment of CNVM if present. SMH drainage, macular translocation and RPE patch grafting are reserved for more severe extensive cases of SMH. Using these techniques, outcomes better than the natural history have been achieved. This review aims to summarise what is known about SMH in nAMD and will discuss a variety of therapeutic interventions.
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Inibidores da Angiogênese/uso terapêutico , Hemorragia Ocular , Degeneração Macular/complicações , Neovascularização Retiniana , Hemorragia Ocular/tratamento farmacológico , Hemorragia Ocular/etiologia , Hemorragia Ocular/cirurgia , Humanos , Neovascularização Retiniana/tratamento farmacológico , Neovascularização Retiniana/etiologia , Neovascularização Retiniana/cirurgiaRESUMO
BACKGROUND/AIMS: To evaluate retrospectively the clinical outcomes of patients presenting with submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD), treated by vitrectomy, submacular tissue plasminogen activator (tPA) injection and pneumatic displacement of SMH with air followed by postoperative intravitreal ranibizumab (RZB). METHODS: Patients with SMH and nAMD had 25-guage vitrectomy and subretinal tPA (12.5 micrograms/0.1 mL) with fluid/air exchange. Intravitreal RZB was administered postoperatively to patients eligible for National Health Service (NHS) funded treatment. RESULTS: Of the total of 16 patients, 11 (68.7%) had complete displacement of SMH. The remaining five had residual SMH, mainly subretinal pigment epithelium in location. Three of the four patients who previously had a failed expansile gas pneumatic displacement were successfully displaced with vitrectomy surgery. At presentation 5/16 (31.3%) patients were eligible for NHS funded intravitreal RZB. This increased to 12 patients after the vitrectomy procedure (75.0%). At 6 months postoperatively all improved by >/=1 line. Ten of the 16 patients (63%) improved by >/=2 lines, with 10 of the 12 patients (83%) treated with RZB improving by >/=2 lines. CONCLUSION: Vitrectomy/subretinal tPA/air to displace SMH followed by intravitreal RZB injection can stabilize/improve vision in patients with nAMD. This technique displaces hemorrhage not displaced by attempted expansile gas techniques.