Performance of an iPad Application to Detect Moderate and Advanced Visual Field Loss in Nepal

iPad, Application, Visual Field Loss

2017 Aug 24. pii: S0002-9394(17)30341-0. doi: 10.1016/j.ajo.2017.08.007. [Epub ahead of print]

Performance of an iPad Application to Detect Moderate and Advanced Visual Field Loss in Nepal.

Abstract

PURPOSE:

To evaluate the accuracy and efficiency of Visual Fields Easy (VFE), a free iPad app, for performing suprathreshold perimetric screening.

METHODS:

We performed screening visual fields using a calibrated iPad 2 with the VFE application on 206 subjects (411 eyes): 210 normal (NL), 183 glaucoma (GL) and 18 diabetic retinopathy (DR) at Tilganga Institute of Ophthalmology, Kathmandu, Nepal. We correlated the results with a Humphrey Field Analyzer using 24-2 SITA Standard tests on 273 of these eyes (198 NL, 160 GL, 15 DR) RESULTS: The number of missed locations on the VFE correlated with Mean Deviation (MD, r=0.79), Pattern Standard Deviation (PSD, r = 0.60), and number of locations that were worse than the 95% confidence limits for Total Deviation (r=0.51) and Pattern Deviation (r=0.68) using SITA Standard. iPad suprathreshold perimetry was able to detect most visual field deficits with moderate (MD of -6 to -12 dB) and advanced (MD worse than -12 dB) loss, but had greater difficulty in detecting early (MD better than -6 dB) loss, primarily due to an elevated false positive response rate. The average time to perform the Visual Fields Easy test was 3 minutes 18 seconds (s.d = 16.88 seconds).

iPad, Application, Visual Field Loss

DISCUSSION:

The Visual Fields Easy test procedure is a portable, fast, effective procedure for detecting moderate and advanced visual field loss. Improvements are currently underway to monitor eye and head tracking during testing, reduce testing time, improve performance and eliminate the need to touch the video screen surface.

KEYWORDS:

Abstract: 249; Design: Prospective; Word Count: Manuscript: 2928; cross sectional; diabetic retinopathy; glaucoma; iPad; tablet display; validation study; visual field screening; visual impairment

PMID:
28844641
DOI:
10.1016/j.ajo.2017.08.007

 

Management of postoperative inflammation after cataract and complex ocular surgeries

Management,postoperative inflammation,cataract, ocular surgeries

 

Send to Br J Ophthalmol. 2017 Aug 3. pii: bjophthalmol-2017-310324. doi: 10.1136/bjophthalmol-2017-310324. [Epub ahead of print] Management of postoperative inflammation after cataract and complex ocular surgeries: a systematic review and Delphi survey. Aptel F1, Colin C2, Kaderli S3, Deloche C3, Bron AM4, Stewart MW5, Chiquet C1. Author information Abstract Prevention and management of postoperative ocular inflammation with corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) have been evaluated in several randomised controlled trials (RCTs). However, neither consensus regarding the efficacies of different regimens nor established guidelines are currently available. This has resulted in different practice patterns throughout the world. A systematic literature review found that for the management of postcataract inflammation nepafenac produced a positive outcome in three of three RCTs (3/3), as did ketorolac (1/1), bromfenac (7/7), loteprednol (3/3) and difluprednate (6/6), but not flurbiprofen (0/1). A single study found that betamethasone produced inconclusive results after retinal detachment (RD) surgery; ketorolac was effective (1/1) after vitrectomy, but triamcinolone was ineffective (0/1) after trabeculectomy. A two-round Delphi survey asked 28 international experts to rate both the inflammatory potential of different eye surgeries and their agreement with different treatment protocols. They rated trabeculectomy, RD surgery and combined phacovitrectomy as more inflammatory than cataract surgery. Vitrectomies for macular hole or epiretinal membrane were not deemed more inflammatory than cataract surgery. For trabeculectomy, they preferred to treat longer than for cataract surgery (NSAID + corticosteroid three times a day for 2 months vs 1 month). For vitrectomy alone, RD surgery and combined phacovitrectomy, the panel preferred the same treatment as for cataract surgery (NSAID + corticosteroid three times a day for 1 month). The discrepancy between preferred treatment and perception of the eye’s inflammatory status by the experts for RD and combined vitreoretinal surgeries highlights the need for RCTs to establish treatment guidelines. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Management,postoperative inflammation,cataract, ocular surgeries

KEYWORDS: Clinical Trial; Drugs; Glaucoma; Retina; Treatment Surgery PMID: 28774934 DOI: 10.1136/bjophthalmol-2017-310324

Cataract Study II: reducing complications by preoperative risk stratification and case allocation

Cataract , complications, teaching hospital
2017 Jun 27. pii: S0002-9394(17)30259-3. doi: 10.1016/j.ajo.2017.06.014. [Epub ahead of print]

The Auckland Cataract Study II: reducing complications by preoperative risk stratification and case allocation in a teaching hospital.

Abstract

PURPOSE:

To assess the effect of preoperative risk stratification for phacoemulsification surgery on intraoperative complications in a teaching hospital. Design; Prospective cohort study.

METHODS:

Prospective assessment of consecutive phacoemulsification cases (N=500) enabled calculation of a risk score (M-score of 0-8) using a risk stratification system (Muhtaseb et al). M-scores of >3 were allocated to senior surgeons. All surgeries were performed in a public teaching hospital setting, Auckland, New Zealand, in early 2016. Post-operatively data were reviewed for complications and corrected distance visual acuity (CDVA). Results were compared to a prospective study (N=500, Phase 1) performed prior to formal introduction of risk stratification.

RESULTS:

Intraoperative complications increased with increasing M-scores (P=0.044). Median M-score for complicated cases was higher (P=0.022). Odds ratio for a complication increased 1.269 per unit increase in M-score (95% CI 1.007-1.599, P=0.043). Overall rate of any intraoperative complication was 5.0%. Intraoperative complication rates decreased from 8.4% to 5.0% (OR=0.576, P=0.043) comparing Phase 1 and Phase 2 (formal introduction of risk stratification). The severity of complications also reduced. A significant decrease in complications for M=0 (i.e. minimal risk cases) was also identified comparing the current study (3.1%) to Phase 1 (7.2%) P=0.034. There was no change in postoperative complication risks (OR 0.812, P=0.434) or in mean postoperative CDVA (20/30, P=0.484) comparing current with Phase 1 outcomes.

CONCLUSION:

A simple preoperative risk stratification system, based on standard patient information gathered at preoperative consultation, appears to reduce intraoperative complications and support safer surgical training by appropriate allocation of higher risk cases.

PMID:
28666731
DOI:
10.1016/j.ajo.2017.06.014

Risk Factors for Glaucoma in a Cohort of Patients with Fuchs Heterochromic Iridocyclitis.

Ocul Immunol Inflamm. 2016 Aug 5:1-7. [Epub ahead of print]

Risk Factors for Glaucoma in a Cohort of Patients with Fuchs Heterochromic Iridocyclitis.

Abstract

PURPOSE:

To describe the incidence and risk factors for ocular hypertension and/or glaucoma in patients with Fuchs heterochromic iridocyclitis (FHC).

METHODS:

Retrospective analysis of 88 patients with FHC. Kaplan-Meier curves estimated the time to develop cataract and ocular hypertension/glaucoma. Possible prognostic factors were investigated in univariate Kaplan-Meier analyses using the Mantel-Cox logrank test.

RESULTS:

At presentation with FHC, 52% of patients had a cataract and 26% of patients had ocular hypertension/glaucoma. The estimated percentage of patients with a cataract or ocular hypertension/glaucoma by 4 years after presentation was 71% (CI: 58-81%) and 39% (CI: 28-51%), respectively. Patients aged ≥50 years had significantly greater risk of developing glaucoma (p = 0.0065). After adjusting for age-group, having a cataract at presentation was associated with increased risk of glaucoma (p = 0.032).

CONCLUSIONS:

Risk factors for development of ocular hypertension/glaucoma were increasing patient age and having a cataract at presentation with FHC.

KEYWORDS:

Cataract; glaucoma; heterochromia; uveitis

Abstract

PURPOSE:

To describe the incidence and risk factors for ocular hypertension and/or glaucoma in patients with Fuchs heterochromic iridocyclitis (FHC).

METHODS:

Retrospective analysis of 88 patients with FHC. Kaplan-Meier curves estimated the time to develop cataract and ocular hypertension/glaucoma. Possible prognostic factors were investigated in univariate Kaplan-Meier analyses using the Mantel-Cox logrank test.

RESULTS:

At presentation with FHC, 52% of patients had a cataract and 26% of patients had ocular hypertension/glaucoma. The estimated percentage of patients with a cataract or ocular hypertension/glaucoma by 4 years after presentation was 71% (CI: 58-81%) and 39% (CI: 28-51%), respectively. Patients aged ≥50 years had significantly greater risk of developing glaucoma (p = 0.0065). After adjusting for age-group, having a cataract at presentation was associated with increased risk of glaucoma (p = 0.032).

CONCLUSIONS:

Risk factors for development of ocular hypertension/glaucoma were increasing patient age and having a cataract at presentation with FHC.

KEYWORDS:

Cataract; glaucoma; heterochromia; uveitis

Cataract Surgery on the Previous Corneal Refractive Surgery Patient

Cataract Surgery, Refractive surgery, Lasik, RK, Complications
Surv Ophthalmol. 2016 Jul 13. pii: S0039-6257(15)30064-3. doi: 10.1016/j.survophthal.2016.07.001. [Epub ahead of print]

Cataract Surgery on the Previous Corneal Refractive Surgery Patient.

Abstract

Cataract surgery in cases with previous corneal refractive surgery may be a major challenge for the ophthalmologist. The refractive outcome of the case deserves special attention in the preoperative planning process, which should be tailored for the type of prior refractive procedure: incisional, ablative under a flap, or on the corneal surface. Avoiding refractive surprise after cataract surgery in these cases is principally dependent upon the accuracy of the IOL calculation, together with the selection of the appropriate biometric formula for each case. Modern techniques for cataract surgery help surgeons to move towards the goal of cataract surgery as a refractive procedure free from refractive error. We give practical guidelines for the cataract surgeon in the management of these challenging cases.

Abstract

Cataract surgery in cases with previous corneal refractive surgery may be a major challenge for the ophthalmologist. The refractive outcome of the case deserves special attention in the preoperative planning process, which should be tailored for the type of prior refractive procedure: incisional, ablative under a flap, or on the corneal surface. Avoiding refractive surprise after cataract surgery in these cases is principally dependent upon the accuracy of the IOL calculation, together with the selection of the appropriate biometric formula for each case. Modern techniques for cataract surgery help surgeons to move towards the goal of cataract surgery as a refractive procedure free from refractive error. We give practical guidelines for the cataract surgeon in the management of these challenging cases.

Avoiding refractive surprise after cataract surgery in these cases is principally dependent upon the accuracy of the IOL calculation, together with the selection of the appropriate biometric formula for each case. Modern techniques for cataract surgery help surgeons to move towards the goal of cataract surgery as a refractive procedure free from refractive error. We give practical guidelines for the cataract surgeon in the management of these challenging cases