Hospital Eye Department Research Articles

Measuring aniseikonia and investigating neuroplasticity and image factors in amblyopia (MAGNIFY): study protocol for a randomised clinical trial

BackgroundAniseikonia represents a potential barrier to neuroplasticity which may limit visual outcomes in children with anisometropic amblyopia. Full correction of refractive error is the first step in standard amblyopia treatment, which corrects for image focus but neglects image size differences.MethodsThe MAGNIFY study is a double-masked, randomised clinical trial investigating the effectiveness of aniseikonia correcting lenses in children at first diagnosis of significant anisometropia. We hypothesis that aniseikonia correction lenses will improve image clarity and reduce the retinal size differences producing better visual acuity and stereoacuity improvements after 15 weeks of optical treatment for children with anisometropia. Eligible children will be randomly allocated to the treatment group (aniseikonia-correcting spectacle lenses) or control group (standard spectacle lenses). Visual acuity and binocular functions will be assessed every 5 weeks during the 15-week optical treatment phase according to standard amblyopia treatment protocol.DiscussionIt is possible that correcting aniseikonia along with anisometropia at first diagnosis will promote binocularity as well as increase spectacle adherence by reducing visual discomfort, improving optical treatment outcomes. This could then reduce the need for additional amblyopia treatment such as patching or atropine, reducing the burden on hospital eye departments and potentially improving visual outcomes for children with amblyopia.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000061932. Registered on 24 January 2020. Protocol 15th November 2019, version one.

Contact lens prescribing trends in the UK hospital eye service

PurposeThe aim of this study was to evaluate the types of contact lenses fitted by hospital optometrists within the Midlands region of the United Kingdom (UK). MethodA questionnaire was sent to all the lead optometrists of the Midlands Hospital Optometry Group (MHOG). This group includes optometry hospital eye departments within the Midlands region of the UK. The questionnaire requested information of their last ten contact lens fitting appointments. Details of the patient’s age, gender, lens type, wearing times, and presenting condition were retrospectively taken from the patients’ records using the appointment diary to identify the last ten patients fitted with contact lenses. ResultsDetails from a total of 109 contact lens fits were collected. This included 45 females and 64 males with a mean age of 39.4 ± 17.4 years. The mean wearing time was 6.3 ± 1.0 days per week and 10.7 ± 5.1 h per day. Sixty-one percent of the contact lenses fitted were for patients with keratoconus and over half of all the contact lenses fitted were corneal rigid gas permeable lenses. ConclusionThis study highlighted that the main reason for fitting contact lenses in hospital contact lens practice is primary corneal ectasia, and mainly keratoconus. Whilst most patients with keratoconus were fitted with corneal rigid gas permeable contact lenses, around 1 in 6 were fitted with soft contact lenses. This study addresses a gap in the literature about contact lenses fitted in UK hospitals and how they differ from community contact lens practice.

Impact of the COVID-19 pandemic\u2019s first wave on the care and treatment situation of intravitreal injections in a German metropolitan region

PurposeThis study aims to evaluate the impact of the first coronavirus 2019 (COVID-19) wave in 2020 on patients scheduled for intravitreal injections (IVI) in a German metropolitan region.MethodsWe performed a multicentre prospective survey and retrospective analysis of the records of patients treated with intravitreal injections during the 20-week period from March to July 2020 in all four hospital eye departments in the city of Hamburg using a questionnaire (on treatment adherence, SarsCoV2-related personal, familial and social data) and treatment data.ResultsA total of 1038 patients (2472 IVI, 1231 eyes) and 818 questionnaires were evaluated. Longer duration of therapy, lower visual acuity (VA) of the treated and higher VA of the fellow untreated eye was were associated with a higher probability of visit cancellation. Every additional year of life posed a 2.6% lower risk of noncompliance. A COVID-19 infection in the family environment displayed a 5.5-fold chance of visit cancellation. Patients treated for neovascular age-related macular degeneration (nAMD) had a 36% reduced risk of visit cancellation compared to patients with diabetic macular oedema (DME).ConclusionA long preceding treatment period, low VA of the treated eye, high VA of the untreated eye, COVID-19 in the family and DME were identified as risk factors for IVI visit cancellations during the COVID-19 pandemic. Compliance to treatment might be improved in the future by taking these risk factors into account when scheduling patients for IVI during the exceptional circumstances of a pandemic.

Shared Care and Virtual Clinics for Glaucoma in a Hospital Setting.

Glaucoma patients require lifelong management, and the prevalence of glaucoma is expected to increase, resulting in capacity problems in many hospital eye departments. New models of care delivery are needed to offer requisite capacity. This review evaluates two alternative schemes for glaucoma care within a hospital, i.e., shared care (SC) and virtual clinics (VCs), whereby non-medical staff are entrusted with more responsibilities, and compares these schemes with the “traditional” ophthalmologist-led outpatient service (standard care). A literature search was conducted in three large bibliographic databases (PubMed, Embase, and Trip), and the abstracts from the prior five annual meetings of the Association for Research in Vision and Ophthalmology were consulted. Twenty-nine were included in the review (14 on SC and 15 on VCs). Patients with low risk of vision loss were considered suitable for these approaches. Among the non-medical staff, optometrists were the most frequently involved. The quality of both schemes was good and improved with the non-medical staff being trained in glaucoma care. No evidence was found on patients feeling disadvantaged by the lack of a doctor visit. Both schemes increased the hospital’s efficiency. Both SC and VCs are promising approaches to tackle the upcoming capacity problems of hospital-based glaucoma care.

Effects of Neodymium-Doped Yttrium Aluminium Garnet (Nd:YAG) Laser Capsulotomy on Visual Outcomes From a Lower-Middle Income Country.

ObjectiveNeodymium-doped yttrium aluminium garnet (Nd: YAG) laser is a non-invasive and effective means to deal with posterior capsule opacification. Although it is safe, it may have some complications. The purpose of this study was to evaluate the efficacy of Nd: YAG laser capsulotomy in terms of visual outcomes.MethodologyThis retrospective study was carried out at the eye department of Shaheed Mohtarma Benazir Bhutto Medical College, Lyari and Sindh Government Lyari General Hospital, Karachi, by using a convenient sampling technique. The duration of the study was six months from 1st January 2020 to 30th June 2020. 50 eyes of patients older than 20 years of age of either gender with posterior capsule opacification after cataract surgery for more than 6 months of duration, capsular fibrosis, and visual distortion due to wrinkling were included in the study. ResultsOur results show that in a total of 50 patients, the mean age was 59.08±5.84 years, of which, 20 (40%) were males. Out of 50 patients, 22 right while 28 left eyes were selected for Nd: YAG laser capsulotomy. None of the patients showed elevated intraocular pressure (IOP) after the 1st week. Mean IOP was 16.84±3.63 mm of Hg on the 1st day and mean IOP after 1st week was 12.48±2.01 mm of Hg. Iritis was observed in 5 (10.0%) patients on the 1st day and 4 (8.0%) patients on the 1st week. Raised IOP was observed in 10 (20.0%) cases whereas cystoid macular edema was observed in only 1 (2%) patients on the 1st day and 1st week after laser therapy.ConclusionThe study predicted that Nd: Yag laser posterior capsulotomy gives excellent results in terms of visual acuity. Complications that were associated with the Nd: Yag laser capsulotomy was a rise in intraocular pressure, cystoid macular edema, iritis, and IOL pitting.

Sutureless Scleral-Fixated Intraocular Lens Implantation in the Treatment of Congenital Lens Subluxation Related to Marfan Syndrome.

To evaluate the efficacy and safety of bimanual capsulorhexis combined with sutureless scleral-fixated intraocular lens (IOL) implantation in children diagnosed as having Marfan syndrome. The study included 14 eyes with subluxated lenses of 7 children who were diagnosed as having Marfan syndrome and underwent bimanual capsulorhexis combined with sutureless scleral-fixated IOL implantation by the same surgeon between 2015 and 2019 at the University of Health Sciences, Kartal Dr. Lütfi Kirdar City Hospital's Eye Department. The mean preoperative and postoperative uncorrected visual acuity was 1.47 ± 0.41 and 0.42 ± 0.15 logarithm of the minimum angle of resolution (logMAR), respectively (P = .001). The preoperative best corrected visual acuity (BCVA) ranged from 1.30 to 0.40 logMAR with a mean value of 0.81 ± 0.30 logMAR. Postoperatively, all patients had an increase in the BCVA with a mean value of 0.20 ± 0.11 logMAR, which was statistically significant (P = .001). The mean preoperative and postoperative spherical equivalent was -9.69 ± 4.59 and -0.27 ± 1.21 diopters, respectively. Despite the small number of patients in this study, good visual results and a low complication rate were obtained in patients with ectopic lens. The long-term IOL status in patients who have undergone sutureless scleral-fixated IOL implantation will make it possible to better evaluate the safety and applicability of the technique. [J Pediatr Ophthalmol Strabismus. 2021;58(6):401-406.].

In Focus: A different direction for community optometry

Barbara Ryan tells Andrew McClean about research exploring how primary care schemes could alleviate pressure on hospital eye departments

Clinical outcomes of the Centre for Eye Health: an intra-professional optometry-led collaborative eye care clinic in Australia

ABSTRACT Clinical relevance: This novel clinical model is the first of its kind in Australia and was designed to help reduce unnecessary referrals into overburdened public systems by utilising pre-existing community-based resources. Background: The Centre for Eye Health (CFEH) is an intra-professional optometry-led care clinic offering an alternative pathway to traditional ophthalmology-based pathways (public hospital clinics or private practices) for ‘at-risk’ patients requiring ocular imaging, diagnostic and management services. This study evaluates the CFEH integrated eye-care model in the identification of chronic eye diseases within the community. Methods: A retrospective random clinical audit of over 750 medical records of patients referred to the CFEH between July 2016 and June 2019 was conducted. Demographics of patients, referral type, final diagnosis and recommended management plans were extracted from this subset. Clinic key performance indicators (referral turnaround time, and net cost per patient appointment) were also extracted. Results: Of the 755 referrals associated with the audited records, 77.4% resulted in the identification of patients with or at-risk of developing eye diseases with 73.5% of this cohort requiring ongoing monitoring at CFEH or referral to ophthalmology. Although the CFEH model is not designed to diagnose or manage acute conditions, 1.5% of patients in this pathway required same day ophthalmological or medical intervention. The cost per patient was equivalent to hospital eye departments costs. Conclusion: This integrated care pathway has the potential to reduce unnecessary referrals from optometrists to hospital ophthalmological service by offering a safe and effective alternate pathway. The majority of patients seen within this pathway were able to be monitored within optometry-led services. This is a unique clinical model utilising inter-professional referrals within optometry which has the potential to reduce preventable blindness within the community through the early detection of eye diseases.

Dynamic Pupillometry in Type 2 Diabetes: Pupillary Autonomic Dysfunction and the Severity of Diabetic Retinopathy.

PurposeAutonomic dysfunction may precede the microvascular changes that characterise diabetic retinopathy. The aim of this pilot study was to measure and compare pupillometry indices in type 2 diabetes (T2DM) patients – with and without diabetic retinopathy – and in healthy, age-matched controls.MethodsTwo hundred and eleven participants with T2DM aged 45–80 years were recruited from Dunedin Hospital Eye Department, Dunedin, New Zealand. They were categorised into three groups – no, mild/moderate, or severe diabetic retinopathy. Seventy age-matched, diabetes screen negative control participants were recruited from the Dunedin city community. Dynamic pupillometry was performed using an infrared pupillometer. The main outcome measures were maximum constriction velocity, average constriction velocity, absolute constriction amplitude, relative reflex amplitude, average dilation velocity and 75% re-dilation (recovery) time. Outcome measures were compared between study groups using the Kruskal–Wallis nonparametric test (with Dunn’s multiple comparison post-test).ResultsPupillary parasympathetic function differed between groups. Maximum constriction velocity (p <0.001) and average constriction velocity (p <0.001) were slower, and absolute constriction amplitude (p <0.001) and relative reflex amplitude (p <0.05) were lower in the three diabetes groups compared with controls. There were no significant differences in pupillary sympathetic function between the four groups for re-dilation time, but the diabetes groups had significantly slower average dilation velocity times.ConclusionPupillary light reflex is significantly impaired with diabetic retinal neuropathy, before clinically observable signs of diabetic retinopathy. Dynamic pupillometry may be a cheap, clinically relevant test, but sensitivity and specificity need to be determined before utilising as a screening tool for diabetic retinopathy.

Dr Dragoljub Đorđević (1866-1942) osnivač i prvi šef Očnog odeljenja Okružne bolnice u Nišu

Ophthalmologist Dr. Dragoljub Djordjević born on 29 December 1866, Belgrade (Serbia), and died on 20 January 1942 Belgrade (Yugoslavia). Author of the ophthalmology in Niš, the founder and first chief of the District Hospital eye department in Niš, the second eye department head of the General State Hospital in Belgrade, a warrior of the Balkan wars and the First World War, the holder of numerous war awards and decorations. He graduated from the Faculty of Medicine in Vienna 1893. The first job is received in Niš decree of August 4th 1894 when he was appointed fizikusa Niš district, district of Pirot. Specialization from eye diseases Dr Dragoljub Djordjević began 1894 in the eye clinic in Vienna (Austria-Hungary Empire), which quickly left and returned in Niš (Serbia), where at the hospital in Nis and the Military Hospital in Niš, diagnosed, treated and surgical treated eye disorders. Specialization from eye diseases finished 1903 by professor Dr. Ernst Fuchs with the University Eye Clinic in Vienna. He was appointed the first Chief District Hospital eye department in Niš 1910, which contains the full 16th voluntarily years, with interruptions during the wars. Dr Dragoljub Djordjević 1919 was appointed head of the second eye department of the State General Hospital in Belgrade. His knowledge of ophthalmology unselfish was conveyed to his student Dr. Zdravko Nižetić known by ophthalmologists ceratoplastics.

Étude PLANOPH : plaintes ophtalmologiques recueillies par le médecin généraliste

Little data concerning the management of eye disease in general medical practice is reported in the literature. The main objective of the study was the description and management of ophthalmologic symptoms encountered by the general practitioner. The study was a quantitative, longitudinal, prospective, multi-center trial conducted in 3 departments in France, with data gathered from medical residents' consultation results. The inclusion criteria were: any new ophthalmologic problem with or without complaint, regardless of the patient's age. The resident filled in an observatory questionnaire collecting data on: the complaint within its context; specific and non-specific reasons for the complaint; identification of the medical problem and the management offered. The consultation data were classified according to the CISP-2. From May 1, 2015 to April 30, 2016, 674 of the 53,463 consultations held by resident investigators were for an ophthalmologic problem, corresponding to a 1.3% incidence. In over 70% of the cases, the ocular complaint was the main reason for the consultation. The majority of the conditions were benign and managed without specialty consultation. Eighty-six percent of the consultations lead to medication prescription, including 47% topical antibiotics. Eleven percent of the consultations led to referral to a hospital emergency or eye department. Additional multidisciplinary studies could compliment this study and enable a global vision of patients' clinical care pathways.

Phacoemulsification and endocyclophotocoagulation in uncontrolled glaucoma: Three-year results

To describe the 3-year outcomes of combined cataract surgery and 360-degree endocyclophotocoagulation (ECP) in eyes with uncontrolled glaucoma and no previous glaucoma drainage surgery. University Hospital Eye Department, Exeter, United Kingdom. Retrospective case series. The study included patients who had combined cataract surgery and 360-degree ECP. The primary outcome measure was intraocular pressure (IOP) reduction at 3years postoperatively. Secondary outcome measures were the cumulative probability of failure of the surgical procedure at 3years and the complications of surgery. Failure was defined by 1 of 2 criteria: (1) IOP higher than 21mm Hg or lower than 6mm Hg or not reduced by 20% from baseline at the 1-, 2-, or 3-year timepoint and (2) further laser or other surgery to reduce IOP at any timepoint. The study comprised 84 patients (84 eyes). The mean IOP dropped from 18.7mm Hg preoperatively to 13.3mm Hg, 13.8mm Hg, and 14.0mm Hg at 1, 2, and 3years postoperatively, respectively. By the 3-year timepoint, 58.3% had met the criteria for failure. The mean number of glaucoma medications was similar at 2.5 at 3years postoperatively compared with 2.6 preoperatively. Nine patients (10.7%) had a significant complication, but all resolved without long-term sequelae. At 3years postoperatively, combined cataract surgery and 360-degree ECP achieved a modest but significant drop in IOP in phakic patients with uncontrolled glaucoma and no previous drainage surgery. There was a low incidence of serious side effects but nearly 60% were classified as failures by 3years.

Improving Patient Access to Intravitreal Anti-Vascular Endothelial Growth Factor Treatment through an Integrated Collaborative Team Care Approach

Aim: Intravitreal anti-vascular endothelial growth factor (Anti-VEGF) has become a mainstream treatment for many ophthalmic conditions. Consequently, the demand for the treatment has significantly increased. The significant resource constrained environment necessitated the Palmerston North Hospital Eye Department (PNHED) to introduce solutions to address this increased demand. The two main initiatives adopted were: senior nurse-led macular review clinic (MRC) and nurse-led intravitreal injection clinic. This article will review our current service accessibility and to directly compare it to the results shown in the previous two audits. Method: The data were collected on an updated macular review clinic patient prospective database and Zeiss optical coherence topography (OCT) forum viewer. The study population was determined by those who have received the intravitreal injection treatment (IVT) between January 2015 and November 2017. Results: The average waiting times between IVT and subsequent review clinic as well as review clinic and subsequent IVT have been reduced when compared to the previous audit findings. The average period for the unintended delay between the IVT sessions is 6.07 days. The number of IVT given per year has also increased dramatically every year. Conclusion: PNHED has successfully incorporated both nurses-led MRC clinics and nurse-led IVT clinics. They resulted in a reduction in unintended delays for both reviews and treatment. A secondary benefit of this resource reallocation has been to improve the accessibility of senior medical officer (SMO) clinic appointments. This has reduced the wait time for new patients requiring initial SMO assessment before starting on IVT.

Diagnosis and management of childhood squints: investigation and examination with reference to red flags and referral letters.

Strabismus (squint) is a condition in which the eyes are misaligned. While one eye is directed at an object, the other eye may turn in (esotropia), out (exotropia), up (hypertropia), or down (hypotropia). This misalignment may be persistent or intermittent. Newborn babies may have evidence of intermittent horizontal strabismus, which may be normal. Any baby who continues to suffer from strabismus beyond the age of 3 months should be referred to secondary care for further investigations. The overwhelming majority of squints in children will be benign and can be referred for further investigation on a routine basis. However, if there are any red flags (Box 1) the child should be referred urgently (within a few days) to a hospital eye department (not an optician). Box 1. ### Red flags Strabismus could be a sign of coexisting ocular pathology, for example, retinoblastoma or intracranial pathology, as where there is a tumour requiring urgent management. If this is suspected then an urgent specialist opinion should be obtained. Other red flags are: Finding abnormal neurological signs should prompt referral to a paediatrician. Timely referral and diagnosis is important because strabismus can be a sign …

Pattern of refractive errors among the patients presenting to eye department of district hospital of Uttarakhand

Introduction: Refractive errors are the most common eye disorder encountered in eye OPD of any region worldwide. Global estimates indicate that more than 2.3 billion people in the world suffer from poor vision due to refractive error (RE), this study was conducted to see the pattern of refractive errors in patients of district hospital, which serves most of the population of hilly region of Garhwal, Uttarakand. Material and Methods: The present hospital based prospective study was conducted in the department of ophthalmology, district hospital Dehradun. All patients from the age of 5 and above attending the eye OPD were taken for the study for the period of 2 months from 25 April’16 to 24 June’16. They were referred for refraction after proper anterior and posterior segment evaluation. Presbyopia was not analysed in our study. Results: During the study period 1986patients attended the eye OPD. Out of which 259(13.04%) had refractive error. Out of which 98 were male(37.84%) and 161 were female(62.16%), age of the patients varied from 5 to 65 years with a mean age of 31.89 years. Among them 93(35.91%) had myopia, 73 (28.19%) had hypermetropia, 49(18.92%) had ATR astigmatism, 25(9.65%) had with the rule astigmatism, 19(7.33%) had oblique astigmatism. Discussion: Refractive errors are important cause of visual impairment in developing countries, specially in remote areas, it is very difficult to provide efficient refraction services. Among the refractive errors, myopia was the commonest, constituting 35.91% of all refractive errors. Followed by hypermetropia 28.19%, ATR astigmatism 18.92%, WTR astigmatism 9.64%, oblique astigmatism 7.34%. It was seen that prevalence of myopia is more in younger age group of 15 to 24 years as compared to hypermetropia, which is increasing with age, with peak at 46 to 55 years. It was seen that hypermetropia was also more common among women(p

Preschool children's vision screening in New Zealand: a retrospective evaluation of referral accuracy

ObjectivesTo assess the accuracy of preschool vision screening in a large, ethnically diverse, urban population in South Auckland, New Zealand.DesignRetrospective longitudinal study.MethodsB4 School Check vision screening records (n=5572) were compared...

Improving patient access to prevent sight loss: ophthalmic electronic referrals and communication (Scotland)

IntroductionWith the number of people with sight loss predicted to double to four million people in the UK by the year 2050, preventable visual loss is a significant public health issue. Sight loss is associated with an increased risk of falls, accidents and depression and evidence suggests that 50% of sight loss can be avoided. Timely diagnosis is central to the prevention of sight loss. Access to care can be a limiting factor in preventable cases. By improving referrals and access to hospital eye services it is possible to treat and minimise the number of patients with preventable sight loss and the impact this has on wider society. Clinical pilot studyIn 2005, NHS Fife took part in a flagship pilot funded by the Scottish government e-health department to evaluate the feasibility, safety, clinical effectiveness, and cost of electronic referral with images of patients directly from community optometrists to Hospital Eye Service (HES). The pilot study showed that electronic referral was feasible, fast, safe, and obviated the need for outpatient appointments in 128 (37%) patients with a high patient satisfaction. Centralised ophthalmic electronic referral unitThe results of the pilot study were presented and in May 2007, the electronic referral system was rolled out regionally in southeast Scotland. Referrals were accepted at a single site with vetting by a trained team and appointments were allocated within 48 hours. Following the implementation of electronic referral, waiting times were reduced from a median of 14 to 4 weeks. Significantly fewer new patients were seen (7462 vs 8714 [p < 0.001]). There were also fewer casualties (1984 vs 2671 [p < 0.001]) and ‘did not arrive' (DNA) new patients (503 vs 635 [p < 0.001]). Eye care integration project (Scotland)In 2010 the Scottish Government Health Department committed £6.6 million to community and hospital ophthalmic services forming the Eyecare Integration Project in 2011. The main aim of this project was to create electronic communication between community optometry practices and hospital eye departments. Five electronic forms were specifically designed for cataract, glaucoma, macula, paediatric and general ophthalmic disease. A Virtual Private Network was created which enabled optometrists to connect to the Scottish clinical information gateway system and send referrals to hospital and receive referral status feedback. Numerous hurdles have been encountered and overcome in order to deliver this project. DiscussionAn efficient unique system has been described within the NHS whereby the provision of eye care has been modernised by creating a user-friendly electronic interface between the community and HES. This system ensures patients are vetted into the correct specialist clinic and thus will be less likely to go blind from treatable conditions. Urgent conditions will continue to be prioritised and savings made with efficiencies gained can be re-invested towards better overall patient care.

The Peterborough Scheme for Community Specialist Optometrists in Glaucoma: Results of 4 Years of a Two-Tiered Community-Based Assessment and Follow-up Service

Aims: To report on results of an innovative glaucoma shared-care scheme based in Peterborough, UK.Methods: A retrospective review of all new appointments with 11 community-based specialist optometrists in glaucoma (SOG) was conducted. There are two tiers of SOG, whereby tier 2 SOGs have increased levels of autonomy. All optometrist assessments were reviewed by a consultant ophthalmologist, and levels of agreement were calculated for assessment of optic nerve head appearance, Humphrey visual field test interpretation, diagnosis and outcome.Results: 1639 new patients were assessed by SOGs over a 4-year period. The median waiting time for patients from referral to SOG assessment was 0 days (IQR 0–56), and from SOG assessment to consultant review in a virtual clinic was 12 days (IQR 8–18days). After first appointment, over 60% of patients were classified as low-risk and remained within the SOG scheme. Rates of frank disagreement between SOG and consultant regarding diagnosis and proposed outcome were 5.6 and 10.4%, respectively, for tier 2 SOGs and 15.3 and 28.6%, respectively, for tier 1 SOGs.Conclusions: The SOG scheme demonstrates acceptable levels of accuracy between SOG and glaucoma consultant. This scheme allows many stable low-risk patients to remain out of hospital eye department outpatient clinics.

Relationship between angiotensin I-converting enzyme insertion/deletion gene polymorphism and retinal vein occlusion.

To evaluate the association between angiotensin I-converting enzyme insertion/deletion (ACE I/D) gene polymorphism and retinal vein occlusion (RVO). A total of 80 patients with retinal vein occlusion who was admitted to the Eye Department of Kartal Training and Research Hospital between 2008 and 2011, and 80 subjects were enrolled in this retrospective case–control study. Patients who experienced RVO within one week to six months of study enrolment were included, and those with coronary artery diseases, prior myocardial infarction history and coagulation disturbances were excluded from the study. The diagnosis was made by ophthalmoscopic fundus examination and fluorescein angiography. The ACE gene I/D polymorphism was determined by polymerase chain reaction, and the ACE gene was classified into three types: I/I, I/D and D/D. In multivariate logistic regression analysis, ACE D/D genotype (p = 0.035), diabetes-mellitus (p = 0.019) and hypertension (p = 0.001) were found to be independent predictive factors for RVO. The results of the present study reveal that ACE D/D polymorphism is an independent predictive factor for RVO. However, one cannot definitely conclude that ACE gene polymorphism is a risk factor for retinal vein occlusion.

Levels of State and Trait Anxiety in Patients Referred to Ophthalmology by Primary Care Clinicians: A Cross Sectional Study

PurposeThere is a high level of over-referral from primary eye care leading to significant numbers of people without ocular pathology (false positives) being referred to secondary eye care. The present study used a psychometric instrument to determine whether there is a psychological burden on patients due to referral to secondary eye care, and used Rasch analysis to convert the data from an ordinal to an interval scale.DesignCross sectional study.Participants and Controls322 participants and 80 control participants.MethodsState (i.e. current) and trait (i.e. propensity to) anxiety were measured in a group of patients referred to a hospital eye department in the UK and in a control group who have had a sight test but were not referred. Response category analysis plus infit and outfit Rasch statistics and person separation indices were used to determine the usefulness of individual items and the response categories. Principal components analysis was used to determine dimensionality.Main Outcome MeasureLevels of state and trait anxiety measured using the State-Trait Anxiety Inventory.ResultsState anxiety scores were significantly higher in the patients referred to secondary eye care than the controls (p<0.04), but similar for trait anxiety (p>0.1). Rasch analysis highlighted that the questionnaire results needed to be split into “anxiety-absent” and “anxiety-present” items for both state and trait anxiety, but both subscales showed the same profile of results between patients and controls.ConclusionsState anxiety was shown to be higher in patients referred to secondary eye care than the controls, and at similar levels to people with moderate to high perceived susceptibility to breast cancer. This suggests that referral from primary to secondary eye care can result in a significant psychological burden on some patients.