Causes of Missed Referrals to Low-Vision Rehabilitation Services: Causes in a Tertiary Eye Care Setting

Purpose: To identify the referral pattern and identify causes of missed referrals to low-vision services in a tertiary eye care center. Methods: A retrospective review of all the hospital records of patients seen from September-December 2012 was done to identify patients with visual impairment. Low vision was defined as has a best-corrected visual acuity (BCVA) in the better eye of <20/60 to light perception (as per WHO definition); or a visual field of <20° from the point of fixation. The frequency of referrals in this database was used to identify referral patterns of physicians and also causes for missed referrals for these patients. Results: Of 14,938 hospital medical records reviewed during the period, 499 patients missed low-vision services with a mean age of 46?±?18.2 years, including 158 females. Among those missed, 12.07% were in the age group 0-15 years, while 30.9% of the patients were >60 years, with 157 requiring rehabilitative services and training. Causes for missed referrals were clear misses or non-referrals by the physician (39%), non-acceptance of services by the patient (53%), loss from appointment desks (4.5%), and loss to follow-up (3.5%). Conclusion: Missed referral to low-vision services in tertiary centers can be considerable; these need to be identified for optimal utilization and delivery of these services to patients with low vision.     

Ocular Surface Disease Index© and the five-item dry eye questionnaire: A comparison in Indian patients with dry eye disease

Purpose:To compare the suitability of the Ocular Surface Disease Index (OSDI) and the 5-item Dry Eye Questionnaire (DEQ-5) in Indian patients with dry eyes.Methods:This cross-sectional study evaluated the OSDI and DEQ-5 in patients with tear film abnormalities. Tear film breakup time, tear film height, Schirmer’s I, lissamine green staining, and meibomian gland expressibility were performed on each patient.Results:There were 101 patients with symptoms and/or signs of tear film abnormality. Both OSDI and DEQ-5 questionnaires significantly correlated (ρ = 0.566, P < 0.0001) with each other. The OSDI questionnaire showed a good correlation with all dry eye tests, whereas the DEQ-5 correlated significantly only with the tear film breakup time and the lissamine green score. None of the questionnaires correlated with meibomian gland expressibility. The Bland–Altman analysis revealed a marginal bias (−0.01 unit) for DEQ-5. The DEQ-5 scored higher in patients with mild symptoms. While 101 (100%) patients answered all the questions in the DEQ-5, only 19 (18.8%) patients answered all the questions in the OSDI questionnaire. The least responses were recorded in the vision-function-related and environmental trigger subscales of the OSDI.Conclusion:The OSDI and DEQ-5 scores showed a moderate correlation. The OSDI questionnaire correlated with a higher number of dry eye tests than the DEQ-5. The large number of skipped questions in the vision-function-related and environmental trigger subscales of the OSDI suggests that the questionnaire is not adequately adapted to the Indian population. Patients with a negative OSDI score should be reassessed with the DEQ-5 to exclude symptom positivity.     

老年低视力患者生活质量与护理服务需求的研究

目的：通过调查老年低视力患者的生活质量及其护理服务需求,为提高和改善老年低视力群体的生活质量提供理论依据。

方法：采用横断面的研究方法,以福州市某三甲医院老年低视力患者200例为研究对象,采用中文版低视力生活质量量表(CLVQOL)、护理服务需求问卷表进行调查。

结果：老年低视力患者生活质量得分为54.92±12.11分,护理服务需求得分为30.34±8.93分,中、高需求者为88%。生存质量与护理服务需求呈负相关(r = -0.266,P<0.01)。

结论：老年低视力患者的生活质量水平较低,护理服务需求高,尤其是视功能康复训练方面的护理服务需求。针对我国面临老龄化日趋严重的重要社会问题,重视老年低视力群体的护理服务需求,探讨提供精准的视觉护理服务干预,提高其生活质量是非常必要的。     

The content of optometric eye examinations for a young myope with headaches

BACKGROUND: A recent review found standardised patient (SP) methodology to be the gold standard methodology for evaluating clinical care. We used this to investigate the content of optometric eye care for a young myopic patient with headaches suggestive of migraine. METHODS: We recruited 100 community optometrists who consented to be visited by an unannounced actor for an eye examination and to have that eye examination recorded. The actor received extensive training to enable accurate reporting of the content of the eye examinations, via an audio recording and a checklist completed for each clinical encounter. The actor presented as a 20-year-old student seeking a private eye examination and complaining of symptoms suggestive of migraine headaches. The results of each clinical encounter were recorded on a pre-designed checklist based on evidence-based reviews on headaches, clinical guidelines and the views of an expert panel of optometrists. RESULTS: The presence of headache was detected in 98% of cases. Eight standard headache questions were considered to be the gold standard for primary care headache investigation. Although none of the optometrists asked all of these questions, 22% asked at least four of the eight questions. Sixty-nine per cent of practitioners asked the patient to seek a medical opinion regarding the headaches. The proportion of the tests recommended by the expert panel that was carried out varied from 33% to 89% and the durations of the eye examination varied from 5 to 50 min. CONCLUSION: SP encounters are an effective way of measuring clinical care within optometry and should be considered for further comparative measurements of quality of care. As in research using SPs in other healthcare disciplines, our study has highlighted substantial differences between different practitioners in the duration and depth of their clinical investigations. This highlights the fact that not all eye examinations are the same and that there is no such thing as a 'standard sight test'. We recommend that future optometric continuing education could usefully focus on migraine diagnosis and assessment.     

XEN® implant and trabeculectomy medium-term quality of life assessment and comparison of results

AIM: To evaluate and compare the quality of life of patients submitted to XEN® implant or trabeculectomy and the relationship with potentially involved variables. METHODS: A cross-sectional study of patients with advanced open-angle glaucoma who underwent implantation of XEN® (group 1) and trabeculectomy (group 2) between October 2015 and February 2017. The studied variables were: age, gender, follow-up time, need of topical anti-hypertensive therapy, visual acuity and intraocular pressure (IOP). The quantification of the quality of life was attained through the Glaucoma Symptom Scale (GSS) questionnaire. RESULTS: Totally 34 eyes (34 patients) were included, 17 in each group. The mean GSS scores for group 1 were 42.6±6.8 (median, 47; p25, 36.5; p75, 48.5) and for group 2 it was 41.6±7.0 (median, 43; p25, 36.5; p75, 47.0; P=0.34). There was a strong negative correlation between the need for topical anti-hypertensive drugs and the GSS result in both groups (r=-0.88, P<0.01, r=-0.59, P=0.01, respectively) and a moderate negative correlation with IOP in group 1 (r=-0.50, P=0.03). CONCLUSION: The analysis demonstrates the non-inferiority of medium-term quality of life of one group in relation to the other (XEN® implant and trabeculectomy). The number of topical anti-hypertensive drugs and IOP negatively influenced the quality of life.     

Effectiveness of low vision services in improving patient quality of life at Aravind Eye Hospital

Context:In India, where the heavy burden of visual impairment exists, low vision services are scarce and under-utilized.Aims:Our study was designed to survey the effectiveness of low vision exams and visual aids in improving patient quality of life in southern rural India.Results:About 44 of 55 low vision patients completed baseline and follow-up LVQOL surveys, and 30 normal vision controls matched for age, gender, and education were also surveyed (average 117.34 points). After the low vision clinic visit, the low vision group demonstrated a 4.55-point improvement in quality of life (from 77.77 to 82.33 points, P = 0.001). Adjusting for age, gender, and education, the low vision patients who also received LVAs (n = 24) experienced an even larger increase than those who did not (n = 20) (8.89 points, P < 0.001).Conclusion:Low vision services and visual aids can improve the quality of life in South Indian rural population regardless of age, gender, and education level. Thus, all low vision patients who meet the criteria should be referred for evaluation.     

Quality of life in glaucoma patients after selective laser trabeculoplasty

AIM: To compare quality of life and treatment satisfaction between patients who had selective laser trabeculoplasty (SLT) and those on medication. METHODS: A prospective clinical trial on 143 glaucoma patients that received SLT and a control group that continued using anti glaucoma medication was conducted. Tear break-up time (BUT), punctuate keratitis, need for help, use of artificial tears and the treatment satisfaction survey of intraocular pressure (IOP) were measured at baseline, 6 and 12mo. RESULTS: SLT was able to reduce the mean number of medications needed from 1.56±0.81 to 0.42±0.66 at six months and to 0.33±0.69 at one year. Punctuate keratitis was observed significantly less often (12.24%) after SLT than before (35.94%; P=0.03). Use of artificial tears and BUT did not change significantly after SLT (P>0.05). At baseline, patients in the SLT group were significantly less convinced of medication effectiveness (P=0.006) and complained more about side effects (P=0.003). After SLT, these patients had significantly more confidence in their therapy (P<0.001), showed less side effects (P=0.006), complained less about changes in appearance of the eyes (P=0.003) and were less inconvenienced by the use of eye drops (P<0.001). CONCLUSION: SLT is able to improve treatment-related quality of life in glaucoma patients.     

The content of optometric eye examinations for a presbyopic patient presenting with symptoms of flashing lights

Background: Standardised patients (SPs) are the gold standard methodology for evaluating clinical care. This approach was used to investigate the content of optometric eyecare for a presbyopic patient who presented with recent photopsia. Methods: A total of 102 community optometrists consented to be visited by an actor for a recorded eye examination. This actor received extensive training to enable accurate reporting of the content of the eye examinations, via an audio recording and a checklist completed for each clinical encounter. The actor presented unannounced (incognito) as a 59‐year‐old patient seeking a private eye examination and complaining of recent onset flashing lights. The results of each clinical encounter were recorded on a pre‐designed checklist based on evidence‐based reviews on photopsia, clinical guidelines and the views of an expert panel. Results: The presence of the symptom of photopsia was proactively detected in 87% of cases. Although none of the optometrists visited asked all seven gold standard questions relating to the presenting symptoms of flashing lights, 35% asked four of the seven questions. A total of 85% of optometrists asked the patient if he noticed any floaters in his vision and 36% of optometrists asked if he had noticed any shadows in his vision. The proportion of the tests recommended by the expert panel that were carried out varied from 33 to 100% with a mean of 67%. Specifically, 66% recommended dilated fundoscopy to be carried out either by themselves or by another eyecare practitioner, and 29% of optometrists asked the patient to seek a second opinion regarding the photopsia. Of those who referred, 70% asked for the referral to be on the same day or within a week. Conclusion: SP encounters are an effective way of measuring clinical care within optometry and should be considered for further comparative measurements of quality of care. As in research using SPs in other healthcare disciplines, our study has highlighted substantial differences between different practitioners in the duration and depth of their clinical investigations. This highlights the fact that not all eye examinations are the same but inherently different and that there is no such thing as a ‘standard sight test’. Future optometric continuing education could focus on history taking, examination techniques and referral guidelines for patients presenting with symptoms of posterior vitreous detachment, retinal breaks and secondary retinal detachment.     

Amblyopia and quality of life: a systematic review

Amblyopia is a common condition, which can affect up to 5% of the general population. Health-related quality-of-life (HRQoL) implications of amblyopia and/or its treatment have been explored in the literature. A systematic literature search was undertaken during the period of 7-14 May 2010 to identify the HRQoL implications of amblyopia and/or its treatment. A total of 35 papers were included in the literature review. The HRQoL implications of amblyopia related specifically to amblyopia treatment, rather than to the condition itself. These included impact on family life, social interactions, difficulties in undertaking daily activities, as well as feelings and behaviour. The identified studies adopted a number of methodologies. The study populations included children with the condition, parents of children with amblyopia, and adults who had undertaken amblyopia treatment as a child. Some studies developed their own measures of HRQoL, and others determined HRQoL through proxy measures. The reported findings of the HRQoL implications are of importance when considering the management of cases of amblyopia. The issues identified in the literature review are discussed with respect to how HRQoL is measured (treatment compliance vs proxy measures), and whether HRQoL is taken from a child's or a parent's perspective. Changing societal views over glasses and occlusion therapy are also discussed. Further research is required to assess the immediate and long-term effects of amblyopia and/or its treatment on HRQoL using a more standardised approach.     

Parkinson's disease: a review of the medical and optometric aspects

Parkinson's disease is relatively common in the elderly patients of optometrists. The general medical and ocular signs, symptoms and management of the disease are reviewed. Suggestions are made to improve the ocular examination and subsequent management of the special eye problems which these patients experience.     

Outcomes of esotropia surgery in Saudi Arabia: An audit from a single center

Purpose

To monitor the outcomes of surgical correction of esotropia in order to improve preoperative counselling for patients and their families.

Cataract surgery in Australia: a profile of patient-centred outcomes

BACKGROUND: Few studies have addressed quality of life or satisfaction outcomes for patients undergoing cataract surgery, particularly in Australia. The purpose of this study was to describe a sample of patients undergoing cataract surgery in typical metropolitan practices in Sydney, with a particular focus on the impact upon quality of life and satisfaction with vision. METHODS: One hundred and eleven patients were recruited prior to surgery and followed through 3 months postoperatively. Patients reported basic demographic information, VF-14 visual disability and SF-36 quality of life information, along with the degree of satisfaction and trouble with vision they experienced. Surgeons' records provided information about type and severity of cataract, refractive error, ocular comorbidity and visual acuity. RESULTS: Patients enjoyed strongly significant improvement in visual acuity, disability, trouble and satisfaction with vision, with a median postoperative Snellen acuity of 6/7.5, and 82% within 1 D refraction. Not wearing glasses was the most commonly stated patient goal for undergoing surgery. Prior to surgery 23% of all driving patients did so illegally due to poor vision; after surgery 21% of non-drivers began driving again, all legally. Nonetheless, quality of life did not improve. Those who failed to achieve improvements in satisfaction with vision were more likely to be female, have lower educational attainment or have high visual function preoperatively. Change in visual acuity was not predictive. CONCLUSIONS: The findings from this study indicate that cataract surgery outcomes in Australia compare well with international standards, and emphasize the inadequacy of visual acuity to measure relevant surgical outcomes. Increased preoperative counselling may be required in those groups less likely to attain high levels of satisfaction. Finally, the role of cataract surgery to improve quality of life must be investigated further, as this is the ultimate goal of the procedure.     

Cataract surgery and changes in quality of life measures

Background: This study examines whether quality of life measured with non‐disease specific instruments is altered by cataract surgery and whether the effect is modulated by the presence of ocular comorbidity or other nonocular issues. Methods: Thirteen patients were assessed pre‐ and at three months post‐cataract surgery. Visual disability was measured with the Visual Disability Assessment. Quality of life was measured using two established generic instruments: the Cantril Ladder and the Profile of Mood States (POMS). Subjects were also asked to report any events that may have influenced their quality of life in the three months after surgery. Results: Visual acuity and visual disability were significantly improved by surgery (p < 0.01). Cantril Ladder score was significantly improved after surgery (p = 0.04). The POMS score improved significantly after surgery, only when cases with ocular comorbidity were excluded (p = 0.04). Two cases had a large deterioration in POMS score that was attributable in one case, to the death of a partner and in the other (a patient with severe glaucoma) to depression from the realisation that there was no further potential for visual improvement. Discussion: Quality of life can be measurably improved by cataract surgery. However, this is less likely if ocular comorbidity is present. The use of generic instruments for outcome studies increases the likely influence of external factors on quality of life measures. Disease specific instruments, such as the Visual Disability Assessment, should be used wherever possible in outcomes research.     

Subjective outcome and quality of life following external dacryocystorhinostomy

Purpose:To assess the patient reported outcome and quality of life in post external dacryocystorhinostomy operated patients.Methods:A prospective questionnaire based study was carried out on 112 patients diagnosed with chronic dacryocystitis who underwent external dacryocystorhinostomy in the department of Orbit and Oculoplasty at a tertiary eye hospital in South India.Results:We included 112 cases in our study. Mean (SD) of the age of patients was 48.03 (12.79) years and ranged from 7 to 72 years of age. 44 (39.3%) patients were males and 68 (60.7%) were females. All cases had subjective symptoms of tearing, pain and swelling at baseline which were relieved by post-operative 3 in all cases. The mean (SD) best corrected visual acuity was 0.28 (0.39) at baseline and 0.25 (0.37) at postoperative 3 (p < 0.001). All four parameters studied in the GBI questionnaire - total mean GBI (32.22 vs 48.86, P < 0.001), general subscale (31.21 vs 44.08, P < 0.001), social health (46.28 vs 61.01, P < 0.001), physical outcome (22.17 vs 55.80, P = 0.0001) scores showed significant improvement from 1 vs 3 months post DCR.Conclusion:The GBI questionnaire is an effective tool for assessing patients’ quality of life following DCR. External DCR can not only produce a successful anatomical outcome but also bring about a measurable improvement in subjective symptoms and quality of life among patients with symptomatic NLDO.     

青光眼与生存质量

青光眼是当今世界范围内的主要致盲性眼病,严重影响患者的生存质量。随着医学模式的转变,单纯观察视功能的变化已不能够全面反映疾病对患者的影响,生存质量作为一种较全面的体现新的健康观和医学模式的评价体系已经引入眼科领域,是传统视功能评价方法的有益补充。本文就国内外与视觉相关的生存质量的研究进展及青光眼患者的生存质量状况和如何提高他们的生存质量作一综述。