Common Ophthalmic Conditions Research Articles

English

Chalazion is a common ophthalmic condition characterized by chronic lipogranulomatous inflammations of the eyelid caused by plugged meibomian glands. It causes local eye symptoms such as irritation, inflammation and cosmetic disfigurement, mechanical ptosis and corneal astigmatism.30 patients of the age group between 15 to 40 years having solitary and multiple chalazia present in upper or and lower lids were included in the study. Triamcinolone acetonide 0.1 ml 0.2ml (4-8mg) was injected from conjunctival approach using a tuberculin syringe. Our results suggest that intra lesional injection of corticosteroid is one the ideal treatment for chalazion especially multiple, bilateral and those near the punctum. In majority of cases one injection is sufficient for complete resolution of the chalazion within a period of a week’s time. Injection can be repeated after a week in cases having residual swelling.

Ophthalmic Disorders Observed in Pet Chinchillas (Chinchilla lanigera)

This article presents a retrospective analysis of ocular disorders observed in outpatient pet chinchillas examined in a veterinary clinic between 2000 and 2010. The most common ophthalmic conditions diagnosed during this time period was alteration of the lens (15 eyes, 10 chinchillas), followed by abnormalities of the cornea (14 eyes, 13 chinchillas), and conjunctival disease (10 eyes, 9 chinchillas). The predominant lens disorder was cataracts, whereas the main alteration of the cornea was fluorescein-positive corneal substance loss. Subtle ocular changes appear to be common in the chinchilla. The data gathered within this study indicate that a thorough ophthalmic evaluation is warranted during routine physical examinations for this species.

Topical Interleukin 1 Receptor Antagonist for Treatment of Dry Eye Disease

The immunopathogenic mechanisms of dry eye disease (DED), one of the most common ophthalmic conditions, is incompletely understood. Data from this prospective, double-masked, randomized trial demonstrate that targeting interleukin 1 (IL-1) by topical application of an IL-1 antagonist is efficacious in significantly reducing DED-related patient symptoms and corneal epitheliopathy. To evaluate the safety and efficacy of treatment with the topical IL-1 receptor antagonist anakinra (Kineret; Amgen Inc) in patients having DED associated with meibomian gland dysfunction. Prospective phase 1/2, randomized, double-masked, vehicle-controlled clinical trial. Seventy-five patients with refractory DED. Participants were randomized to receive treatment with topical anakinra, 2.5% (n = 30), anakinra, 5% (n = 15), or vehicle (1% carboxymethylcellulose) (n = 30) 3 times daily for 12 weeks. Primary outcomes were corneal fluorescein staining (CFS), complete bilateral CFS clearance, dry eye-related symptoms as measured by the Ocular Surface Disease Index, tear film breakup time, and meibomian gland secretion quality. Topical anakinra was well tolerated compared with vehicle, with no reports of serious adverse reactions attributable to the therapy. After 12 weeks of therapy, participants treated with anakinra, 2.5%, achieved a 46% reduction in their mean CFS score (P = .12 compared with vehicle and P < .001 compared with baseline); participants treated with anakinra, 5%, achieved a 17% reduction in their mean CFS score (P = .88 compared with vehicle and P = .33 compared with baseline); and patients treated with vehicle achieved a 19% reduction in their mean CFS score (P = .11). Complete bilateral CFS clearance was noted in 8 of 28 patients (29%) treated with anakinra, 2.5%, vs in 2 of 29 patients (7%) treated with vehicle (P = .03). By week 12, treatment with anakinra, 2.5%, and treatment with anakinra, 5%, led to significant reductions in symptoms of 30% and 35%, respectively (P = .02 and P = .01, respectively, compared with vehicle); treatment with vehicle led to a 5% reduction in symptoms. Treatment with topical anakinra, 2.5%, for 12 weeks was safe and significantly reduced symptoms and corneal epitheliopathy in patients with DED. These data suggest that the use of an IL-1 antagonist may have a role as a novel therapeutic option for patients with DED. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00681109.

Accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification Billing Codes for Common Ophthalmic Conditions

Accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification Billing Codes for Common Ophthalmic Conditions

Needs assessment of ophthalmology education for primary care physicians in training: comparison with the International Council of Ophthalmology recommendations

Background:This cross-sectional survey assessed the adequacy of ophthalmology teaching in undergraduate medical education and evaluated the comfort level of family medicine residents in diagnosing and managing common ophthalmic conditions.Methods:Postgraduate year 1 and 2 family medicine residents at the University of Western Ontario were recruited for this study. The main outcome measures were hours of classroom and clinic-based instruction on ophthalmology during undergraduate medical education, and the comfort level in ophthalmic clinical skills and managing various ophthalmic conditions.Results:In total, 54 (33.3%) of 162 family medicine residents responded to the survey. Residents reported an average of 27.1 ± 35.1 hours and 39.8 ± 47.1 hours of classroom and clinical ophthalmology instruction, respectively. However, most residents (80%) responded as feeling only “somewhat comfortable” or “not at all comfortable” in assessing and managing common ophthalmic conditions, including ocular emergencies, such as acute angle closure glaucoma and ocular chemical burn. A positive correlation was seen between overall comfort level and hours of classroom instruction (P < 0.05).Conclusion:The number of hours of ophthalmology training received by family medicine residents during medical school meets the International Council of Ophthalmology Task Force recommendations. However, family medicine residents appear to be uncomfortable in handling treatable but potentially sight-threatening ocular conditions. Standardizing the undergraduate medical education ophthalmology curriculum and increasing hours of ophthalmology training during postgraduate family medicine residency may be useful in bridging this gap in knowledge.

Ophthalmic skills – Confidence and knowledge of recently graduated doctors

Abstract Purpose Undergraduate medical education in ophthalmology is not standardized in the UK. The purpose of the study was to determine Foundation Year 1 Doctors (FY1) confidence in their own ophthalmic clinical knowledge and skills. Methods Questionnaires were distributed to FY1 at a University Hospital in the United Kingdom. A total of 15 questions were asked and topics ranged from self‐confidence in ophthalmic skills to ones regarding management of common ophthalmic conditions that present to an Accident and Emergency department. Results A total of 20 doctors completed the form. More FY1 felt more confident measuring visual fields (80%) than visual acuity (70%). Only one (5%) was confident in measuring pupillary reflexes. 85% felt that they were not confident in using an ophthalmoscope or needed practise. Even though most were confident in measuring visual fields and 90% could identify a homonymous hemianopia, only 15% could identify a valid cause. Safe management questions were answered poorly with less than 50% correct responses in most questions. 70% indicated an interest in more teaching on practical skills and clinical scenarios in ophthalmology. Conclusion There is a lack of confidence amongst FY1 in clinical skills and in particular with the use of the ophthalmoscope. The majority of FY1 questioned wanted more ophthalmology tuition.

The Economic Implications of Glaucoma

Glaucoma is a common ophthalmic condition, often associated with elevated intraocular pressure (IOP). It affects >2 million people in the US, and the incidence is expected to exceed 3 million by 2020. However, relatively little is known about the cost of glaucoma compared with costs for other eye conditions. This comprehensive report reviews published literature on costs and cost effectiveness of treatments for glaucoma. Cost-of-illness studies in glaucoma focus on direct medical costs and generally exclude indirect costs. In general, increased costs are associated with increased severity or lack of control over IOP and the distribution of costs (e.g. medication vs procedures) varies with severity. A large number of studies have evaluated the cost of glaucoma medications, assessing the number of drops per bottle and associated cost per drop or per treatment dose. These studies have limited usefulness as they generally evaluate unit medication costs without including differential effectiveness or adverse effects associated with various therapies, and thus provide only one component of real-world costs for glaucoma. Broader comparative cost studies, mainly adopting a cost-minimisation approach, have evaluated the impact of differing treatments and management strategies on all types of medical care resource utilisation and associated costs, but a variety of metrics for success makes interpretation challenging. Studies have generally found beta2-adrenoceptor antagonists to be associated with greater healthcare costs than newer therapies. Among newer treatments such as prostaglandin analogues, no specific treatment has demonstrated a clear cost advantage over other treatments. A number of studies have modelled hypothetical cohorts of glaucoma patients through courses of therapy, projecting costs, outcomes and cost effectiveness. A majority of these cost-effectiveness models compare one of the newer prostaglandin analogues with older medications or with one another. Existing studies suggest that bimatoprost may be more cost effective than other agents. However, the effectiveness outcomes used in these studies vary, including achieving IOP thresholds, IOP-controlled days, percent reduction in IOP and QALYs. Methods used to determine costs also vary substantially between studies. Future evaluations of the burden of glaucoma need to consider the issues of comparability between, and generalisability of, study results. Differences in methods have created barriers to understanding the cost of glaucoma and comparing costs or cost effectiveness between studies. Furthermore, future studies should also consider direct costs of glaucoma generally not covered by health insurance as well as indirect costs of glaucoma. As new screening technologies for early detection of individuals at elevated risk of glaucoma are now in use, more complete estimates of the cost of glaucoma are critical for issues of resource allocation and health policy.

Ocular pharmacology

Many new drugs come on the market each year, and some very useful ones become unavailable. Medical treatment of some of the more common ophthalmic conditions observed in small animal practice are discussed in this article. Selection of the appropriate antibiotic or antiviral is critical for effective treatment, and indications for these drugs are provided. Anti-inflammatory medications and their indications and contraindications are also discussed. Medical therapy of glaucoma is also addressed.

Work time estimates for ophthalmic diagnoses and procedures. Results from the Eye Care Workforce Study.

To provide estimates of patient-level annual ophthalmologist work times for the care of common ophthalmic conditions and patient-level global surgical care time for common or important ophthalmic procedures. A random sample of the domestic membership (excluding members-in-training) of the American Academy of Ophthalmology, stratified by self-designated practice concentration, was surveyed in 1994 to provide estimates of work times for common ophthalmic services. Comprehensive and subspecialty-specific results were obtained for ophthalmic diagnoses, services, and surgical procedures. For ophthalmic diagnoses and services, initial and follow-up visit work times are reported for comprehensive and subspecialty ophthalmologists separately. For common surgical procedures, aggregate results based on comprehensive and subspecialist survey responses are reported. These ophthalmology-specific survey results can be used for a variety of purposes, including practice management, "benchmarking," health plan administration and national workforce planning. Such surveys should be repeated as techniques and practice patterns change over time.

Potassium Hydroxide (KOH) Wet Preparation for the Laboratory Diagnosis of Suppurative Corneal Ulcer

Background: Suppurative keratitis is a common ophthalmic condition mostly caused by fungi. Apart from fungal culture, wet preparation using 10% Potassium hydroxide (KOH) for microscopic detection of fungal elements is a rapid and accurate method of laboratory diagnosis. Purpose: This prospective and cross sectional study was undertaken in order to evaluate the diagnostic sensitivity of wet preparation microscopy using KOH for detection of fungal agents from suppurative corneal ulcer patients. Methodology: Fifty six (56) consecutive clinically suspected patients of suppurative corneal ulcer attending Rajshahi Medical College Hospital (RMCH) during the period from July, 06 to June, 07 were included. Corneal swabs were taken aseptically for detection of bacteria in gram-stained smear and culture. Conventional mechanical corneal scrapings were collected under topical anesthesia and utilized for microscopic detection of fungal agents in KOH wet preparation and fungal cultures in the department of Microbiology of Rajshahi Medical College. Results: Culture yielded microbial growths in 47(83.93%) out of 56 samples of corneal ulcer that included 24 (42.86%) pure fungal growths, 14 (25.0%) pure bacterial growths and 09 (16.07%) mixed microbial growths (both bacteria and fungi). Direct microscopical examination using 10% KOH wet preparation detected 28 fungal agents out of total 33 fungal cases (combining both pure and mixed fungal growths in culture). Diagnostic sensitivity of wet preparation microscopy was found to be 84.85% by comparing its performance to fungal culture yields, which is the 'gold standard' for laboratory diagnosis. Conclusion: This limited study has revealed that wet preparation can be a tentative diagnosis of fungal keratitis and can be accurately relied upon for initiating prompt anti-fungal therapy and also recommended as a cost-effective method for laboratory diagnosis especially where culture facility is not available. Key Words: Corneal ulcer; Fungi; Potassium hydroxide; Culture; Diagnostic sensitivity. DOI: 10.3329/bjms.v9i1.5228 Bangladesh Journal of Medical Science Vol.09 No.1 Jan 2010 27-32

Efficacy of lid everting suture in the management of involutional lower eyelid entropion using 4-0 silk versus 4-0 chromic catgut

involutional lower eyelid entropion is a common ophthalmic condition requiring surgical correction. to compare the efficacy of lid everting sutures in the management ofinvolutional lower lid entropion using 4-0 silk versus 4-0 chromic catgut. fifty eyes with involutional lower eyelid entropion were enrolled into the study and divided randomly into two groups, A and B. Group A underwent lid everting suture with 4-0 chromic catgut and group B with 4-0 silk. The parameters assessed were pre- and post-operative lower lid excursion (LLE) and horizontal lid laxity (HLL). data were plotted in the excel spread sheet and analyzed using SPSS 11.0 software program. The difference between the two groups was compared using Chi square test and unpaired t test. while comparing the pre-operative and post-operative changes of HLL within the two groups separately, there was 63% reduction of HLL in group A(p=0.001) and 68% reduction (p=0.001) in group B. In groupA, there was 48.2% improvement in LLE and in group B 52% postoperatively (p=0.001). The success rate in each group was 92%. The cost of surgery in group A was higher than that in group B (p=0.003). lid everting suture by 4-0 silk is as effective as 4-0 chromic catgut. The cost of lid everting suture by 4-0 catgut is higher than that of 4-0 silk. The silk suture can be recommended for correction of lower lid involutional entropion in a country with low socioeconomic status.