Private Eye Research Articles

Bilateral concomitant intravitreal anti-vascular endothelial growth factor injection: Experience in a Nigerian tertiary private eye care facility

To evaluate the indication and safety profile of same-session bilateral intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF). This is a retrospective case series of all the patients that received same-session bilateral intravitreal anti-VEGF in Eye Foundation Hospital, Ikeja, Lagos, from March 2013 to March 2015. Data retrieved from the patients' medical records includes demographics, indications for injections, complications, and systemic comorbidities. During the study period, a total of 442 injections were performed on 126 eyes of 63 patients (M:F ratio; 1.4:1) whose mean age was 55.7 ± 15.6 standard deviation years. The modal age group was 51-70 years. All the patients received injection Bevacizumab (Avastin; Genentech Inc., South San Francisco, California, USA-1.25 mg). The most common primary indication for initiating bilateral intravitreal therapy was diabetic macular edema 23 (36.5%). Mean follow-up period was 40.6 days (range: 1-364 days). A combined diabetes mellitus and hypertension accounted for most of the systemic comorbidities 28 (44.4%). Subconjunctival hemorrhage was the only complication seen in these patients with 6 (9.5%) occurring intraoperatively and 9 (14.3%) postoperatively. There was no association between intraoperative complication and age (P = 0.66) or gender (P = 0.96). Furthermore, there exist no association between postoperative complication and age (P = 0.49) or gender (P = 0.99). No major systemic or ocular adverse events were noted. Given that there are potentially serious complications following anti-VEGF injection, further study with a larger number of patients will be necessary to definitively prove the safety of this treatment modality.

Eye care infrastructure and human resources for managing diabetic retinopathy in India: The India 11-city 9-state study.

Background:There is a paucity of information on the availability of services for diagnosis and management of diabetic retinopathy (DR) in India.Objectives:The study was undertaken to document existing healthcare infrastructure and practice patterns for managing DR.Methods:This cross-sectional study was conducted in 11 cities and included public and private eye care providers. Both multispecialty and stand-alone eye care facilities were included. Information was collected on the processes used in all steps of the program, from how diabetics were identified for screening through to policies about follow-up after treatment by administering a semistructured questionnaire and by using observational checklists.Results:A total of 86 eye units were included (31.4% multispecialty hospitals; 68.6% stand-alone clinics). The availability of a dedicated retina unit was reported by 68.6% (59) facilities. The mean number of outpatient consultations per year was 45,909 per responding facility, with nearly half being new registrations. A mean of 631 persons with sight-threatening-DR (ST-DR) were registered per year per facility. The commonest treatment for ST-DR was laser photocoagulation. Only 58% of the facilities reported having a full-time retina specialist on their rolls. More than half the eye care facilities (47; 54.6%) reported that their ophthalmologists would like further training in retina. Half (51.6%) of the facilities stated that they needed laser or surgical equipment. About 46.5% of the hospitals had a system to track patients needing treatment or for follow-up.Conclusions:The study highlighted existing gaps in service provision at eye care facilities in India.

Kyung-Sung: Cinematic Memories of the Colonial Past in Contemporary Korea

This essay examines two films, Modern Boy (dir. Ji-woo Jeong, South Korea, 2008) and Private Eye (dir. Dae-min Park, South Korea, 2009), both of which depict Seoul in the 1930s—the period during which Korean colonial modernity was fully shaped—and in so doing draw contemporary Koreans' attention to the vibrant facade of the city, a long-forgotten facet of the dark colonial era. It stresses that these films, through their regeneration of lost cultural imagery on the screen, evoke a certain sensibility that is commensurable with guilt. For instance, in a climactic scene in Modern Boy, the male hero walks out of the Chosun Government-General Building and passes the camera. On-screen, as the hero exits from view, the colonial building gradually looms large behind him—beautifully reconstructed in the center of the city, with its iconic aura fully retrieved. At this moment, viewers are awakened to the unfortunate history of Japanese colonialism and thus experience a feeling of regret or melancholy for the past. This cinematic encounter with the past also resonates with cultural imagery of Seoul as a forgotten colonial city that has reemerged across Korean society, especially in worn-out photographs, cinematic reconstructions of lost urban scenery, and even recent repairs of ancient palaces and streets, and suggests how the discursive space that is Seoul accommodates the negativity that buttresses the historical narrative in Korea.

Lincoln’s Spymaster: Allan Pinkerton, America’s First Private Eye by Samantha Seiple (review)

Lincoln’s Spymaster: Allan Pinkerton, America’s First Private Eye by Samantha Seiple (review)

Crossing shadows: Bridging the voices of hard-boiled detective and noir crime fiction

This paper discusses the notion of Voice. It attempts to articulate the nature of voice in hard-boiled detective fiction and noir crime fiction. In doing so, it examines discusses how these narrative styles, particularly found within private eye novels, explores aspects of the subjectivity as the narrator-investigator; and, thus crossing and bridging a cynical, hard-boiled style and an alienated, reflective voice within a noir world.

Artificial Neural Network Approach for Differentiating Open-Angle Glaucoma From Glaucoma Suspect Without a Visual Field Test.

To increase the effectiveness of treating open-angle glaucoma (OAG), we tried to find a screening method of differentiating OAG from glaucoma suspect (GS) without a visual field (VF) test. Data were collected from the Korean National Health and Nutrition Examination Survey (KNHANES) conducted in 2010. Of 8958 participants, 386 suspected OAG subjects underwent a VF test. For the training dataset, five OAG risk prediction models were created using multivariate logistic regression and an artificial neural network (ANN) with various clinical variables. Informative variables were selected by an algorithm of consistency subset evaluation, and cross validation was used to optimize performance. The test dataset was used subsequently to assess OAG-prediction performance using the area under the curve (AUC) of the receiver-operating characteristic. Among five OAG risk prediction models, an ANN model with nine noncategorized factors had the greatest AUC (0.890). It predicted OAG with an accuracy of 84.0%, sensitivity of 78.3%, and specificity of 85.9%. It included four nonophthalmologic factors (sex, age, menopause, and duration of hypertension) and five ophthalmologic factors (IOP, spherical equivalent refractive errors, vertical cup-to-disc ratio, presence of superotemporal retinal nerve fiber layer [RNFL] defect, and presence of inferotemporal RNFL defect). Though VF tests are considered the most important examination to distinguish OAG from GS, they sometimes are impractical to conduct for small private eye clinics and during large scale medical check-ups. The ANN approach may be a cost-effective screening tool for differentiating OAG patients from GS subjects.

The Effects of Empowerment Role Identity and Creative Role Identity on Servant Leadership and Employees’ Innovation Implementation Behavior

The purpose of this paper is to examine whether both empowerment role identity and creative role identity moderate the relationship between servant leadership and innovation implementation behavior. Data were collected from 6 private eye hospitals in Turkey. The sample included 393 office employees and their immediate managers. The obtained data from the questionnaires are analyzed through the SPSS statistical packaged software. Moderated hierarchical regression was used to examine the moderating roles of empowerment role identity and creative role identity on the servant leadership and innovation implementation behavior relationship. The results show that servant leadership is positively and significantly correlated with innovation implementation behavior. In addition, the results of the hierarchical multiple regression analyses support the moderating effects of empowerment role identity and creative role identity with regard to the relationship between servant leadership and innovation implementation behavior.

Microscopy EducationThe Private Eye – (5×) Looking/Thinking by Analogy® Magnifying Minds Using a Jeweler’s Loupe, Everyday Objects, and a Few Simple Questions

Microscopy EducationThe Private Eye – (5×) Looking/Thinking by Analogy^® Magnifying Minds Using a Jeweler’s Loupe, Everyday Objects, and a Few Simple Questions

"Planning eye health services in Varamin district, Iran: a cross-sectional study".

BackgroundA recent survey of avoidable blindness in Varamin District, Iran, identified moderately high levels of visual impairment (10%) and blindness (1.5%) in people >50 years. This study aimed to define current provision, identify gaps and suggest practical solutions for improving eye health services in this area.MethodsThe World Health Organization (WHO) framework for analyzing health systems has several key components: service delivery, health workforce, information system, medical products and technologies, financing, and governance. We used this structure to investigate the strengths and weaknesses of the eye health system in Varamin. All public and private eye care facilities and a random selection of primary health care (PHC) units were assessed using semi-structured researcher-administered questionnaires.ResultsVaramin has 16 ophthalmic clinics, including two secondary hospitals that provide cataract surgery. There were ten ophthalmologists (1:68,000 population), two ophthalmic nurses and five optometrists working in Varamin district. There were no eye care social or community workers, ophthalmic counsellors, low vision rehabilitation staff. Although the Vision 2020 target for ophthalmologists has been met, numbers of other eye care staff were insufficient. The majority of patients travel to Tehran for surgery. The recent survey identified cataract as the leading cause of blindness, despite the availability of surgical services in the district and high health insurance coverage. Poor awareness is a major barrier. No units had a written blindness prevention plan, formal referral pathways or sufficient eye health promotion activities. Only one of the PHC units referred people with diabetes for retinal examination. There is partial integration between eye care services and the general health system particularly for prevention of childhood blindness: chemo-prophylaxis for ophthalmia neonatorum, school vision tests, measles immunization and Vitamin A supplementation.ConclusionsThis analysis demonstrated the need for better integration between eye care services and the general health system, local planning for prevention of blindness, an information system, a better staff mix and health education to increase community awareness and service uptake. There is the capacity to deliver far more surgery locally. All aspects of a health system need to be developed to deliver comprehensive and efficient eye care.

Robert Altman's last hurrah: A Prairie Home Companion

In one sense, Robert Altman's last film, A Prairie Home Companion (2006), follows in the tradition of genre revisionism which he began with the war film (M*A*S*H 1970), the Western (McCabe and Mrs. Miller 1971) and the private eye film (The Long Goodbye 1973). A Prairie Home Companion is Altman's version of the backstage musical: an account of a radio variety show, called A Prairie Home Companion, which is broadcast weekly from the Fitzgerald Theater in St. Paul Minnesota. The film presents this as the final broadcast of the show, because a Texas Corporation has bought out the Fitzgerald for redevelopment, although in fact the radio show continues to this day. But the emphasis on his realistic overturning of genres disguises the extent to which all Altman's films work on the principle of ‘putting on a show’. Realistic detail in performance, camerawork and setting (one of Altman's contributions to the aesthetic of 70s New Hollywood) contributes to building up a picture of a whole world, while we are reminded that this world is a flimsy, artificial construction which must inevitably end. The various acts are performed against a deep black background, as if the end were already encroaching, and an otherworldly ‘dangerous woman’ (in a white trench-coat) prowls through the show, for those whose end has been appointed.

A Private Eye for Private Equity

Private equity investors scouring their portfolios for more value almost always come up with the same ideas, such as dropping unprofitable products and buying more technology. But more than 80%; of potential improvements in their companies don’t require new technology. They hide in the largely unexamined busyness of “knowledge workers.” In almost all business operations that occur away from the factory floor, wasted, avoidable work tasks are often disguised as virtuous—even heroic—effort. That’s how they get dismissed as valuable improvement opportunities. They are not insignificant, but finding them requires a detective like approach—new ways to see the familiar and new places to search. More-conventional strategies will not deliver the competitive advantage private equity investors need.

Endophthalmitis after resident-performed intravitreal bevacizumab injection

ObjectiveTo evaluate the rate of acute endophthalmitis after resident-performed intravitreal bevacizumab (IVB) injections and to compare the results with those performed by attending retina surgeons. DesignRetrospective comparative case series. ParticipantsEight thousand thirty-seven patients treated with intravitreal injection of bevacizumab. MethodsA retrospective chart review of the resident-performed IVB injections at Rassoul Akram Hospital and attending-performed IVB injections at a private eye clinic between 2011 and 2014 was undertaken. Cases of clinical endophthalmitis were identified. ResultsDuring the study interval, the overall incidence rate of postinjection endophthalmitis was 0.01% (1/8037). Antibiotic eye drops were prescribed after IVB injection for 2771 eyes (34.5%). The single case of acute endophthalmitis occurred after a resident-performed injection, and vitreous culture showed growth of Staphylococcus epidermidis. The incidence rate of acute endophthalmitis after resident-performed IVB injection was 0.02% (1/4921). No statistically significant difference was found in the rates of endophthalmitis between resident-performed and attending-performed injections (p = 1). Also, the difference in the rates of endophthalmitis between those receiving postinjection antibiotics and those who did not was not statistically significant (p = 0.3). ConclusionsThe risk for endophthalmitis after resident-performed IVB injection is low and similar to that of the supervising surgeons performing the procedure.

Relationship between Petrochemical Pollution and Oculo-Visual Health in Onelga Region of the Niger Delta

Common sense and simple economics suggest that countries endowed with an abundance of natural resources should prosper. Yet over many years, it has been observed that developing nations rich in oil, gas or mineral resources have been disadvantaged in the drive for economic growth. It is rather unfortunate that, after over fifty years of oil exploration and exploitation in Nigeria, the basic infrastructures seem to be in decay (as roads for instance, are now death traps, power supply is epileptic, poverty is an endemic problem as most of the erstwhile fertile lands in Niger Delta region is infertile and devastated by pollution, which invariably affects the health in general and the oculo-visual health in particular, of inhabitants of that region. The research design of this study was anchored on document analysis, which was based on an examination of records from three private eye clinics in Ogba, Egbema, Ndoni Local Government Area (ONELGA) of Rivers State, Nigeria. The population of this study comprised children, young adults, and workers living in and around ONELGA. The age range of the subjects is 6 months to 70 years. The study revealed that no significant relationship was found between oculo-visual health and general well-being of the citizens. The study concludes that in spite of the fact that there is no significant relationship between petrochemical pollution and oculo-visual health, there is the need to protect the vulnerable in the society from the harmful effects of petrochemicals on oculo-visual well-being. Original Research Article Ihekaire D. E.; OR, 3(4): 100-128, 2015; Article no.OR.2015.017 101

Cataract Surgery Audit at a Private Hospital in Saudi Arabia.

Background:To assess the visual outcomes following cataract surgeries at a Private Eye Hospital in Riyadh, Saudi Arabia.Methods:This was a cohort study of cataract surgeries performed from January to June 2014. Preoperative data were collected on patient demographics presenting and best corrected distance visual acuity (BCVA) and ocular comorbidity. Data were also collected on the type of surgery, type of intraocular lens (IOLs) implanted, and complications. BCVA and refractive status at 6–8 weeks postoperatively were noted. The predictors of vision ≥6/18 were identified.Results:Four hundred eyes of 400 patients underwent cataract surgery. There were 235 (59%) males. Presenting preoperative vision was <6/60 in 52 (13%) eyes. There were 395 (99%) eyes that underwent IOL implantation following phacoemulsification and 4 eyes received a sulcus fixated IOL. A single piece aspheric IOL was implanted in 358 (90%) eyes and a toric IOL was implanted in 31 (8%) eyes. Postoperative BCVA was classified as a “good outcome” (≥6/18) in 320 (80%) and a “poor outcome” (<6/60) in 24 (6%) eyes. Young age (adjusted odds ratio (OR) = 0.97, P = 0.01), male (adjusted OR = 2.4, P = 0.002), and ocular co-morbidities (adjusted OR = 0.2, P < 0.001) were predictors of vision ≥6/18. Complications included a dropped nucleus and a posterior capsular tear in 2 eyes each. Two hundred and fifty-two (63%) eyes were emmetropic or intentionally myopic for distance. Astigmatism <2 D was present in 264 (66%) eyes and astigmatism >2 D was present in 33 (8%) eyes.Conclusion:The recent trend of intentional overcorrection in one eye following modern cataract surgery in order to provide some functional near vision indicates that benchmark for success in getting “good visual outcomes” postoperatively (vision of ≥6/18) may need to be revised.

Scotland’s Wee Dram of Independence

Scotland’s Wee Dram of Independence

영화에 나타난 대한제국기 신여성 의상 이미지 - 〈가비〉, 〈YMCA 야구단〉, 〈그림자 살인〉을 중심으로 -

This study analyzes the visual image and the symbolic image of the 'New Woman' main female characters' costumes in three films: <Gabi>, <YMCA Baseball Team>, and <Private Eye (Geurimja Sarin)>, set in the Korean Empire Period and filmed in the last 10 years. The findings are as follows. First, on the visual image by formative characteristics, Gibson girl style was reflected in Western costume design. Korean costume design is based on a traditional style (or modified in some parts). Second, the three films have the same historical background on the visual image by the fidelity of historical research; however, the fidelity of historical research differs and varies with the personality of characters or situations in the films. Third, all three films share the symbolic image by characteristics of characters and 'New Woman' aspect with the same historical background and 'New Woman' female character in common; however, the personality and 'New Woman' aspect of the characters were somewhat different. There was also a distinct difference in the symbolic image of Western and Korean costumes. Western and Korean costumes signify externality versus internality and denial versus the affirmation of national identity in <Gabi>; dailiness versus ceremonialness and dynamics versus statics in <YMCA Baseball Team>; and independence versus conformity and variability versus continuity in <Private Eye (Geurimja Sarin)>.

Geographical inequalities in uptake of NHS-funded eye examinations: small area analysis of Leeds, UK.

Preventable sight loss is an indicator within the Public Health Outcome Framework 2013-2018 for England. Routinely available optometric data do not permit small area analysis of access inequalities. Data were extracted from 17 680 General Ophthalmic Services (GOS1) claim forms for eye examinations conducted in Leeds during February and March 2011. The expected number of GOS1 uptake for each lower super output area was based on the GOS1 national annual uptake. A Poisson regression model was used to explore associations in the GOS1 uptake ratio with deprivation and gender. People aged 60 or over or under 16 living in the least deprived quintile are 71 and 23%, respectively, more likely to have an NHS-funded eye examination than someone in that age group in the most deprived quintile, although all are equally entitled. Uptake is higher in the more deprived quintiles among 16-59 year olds, as means tested social benefits are the main eligibility criteria in this age group. There were no statistically significant gender differences in uptake. Interventions are needed to address eye examination uptake inequalities. However, in order to better inform commissioning and planning eye care services more complete data with additional detail are required. GOS1 forms ought to be submitted electronically linked to additional demographic and clinical data to allow public health analysis. Ideally, private eye examination data should also be captured.

Service Quality Measurement with SERVQUAL using Analytic Hierarchy Process Model: An Empirical Study of Private Eye Hospitals in Punjab

In the present time, Service providers are facing a constant demand for providing customer oriented services and continuous service improvement is required. It is important to understand customer expectations and their needs effectively so to survive in this competitive market. The five dimensions of SERVQUAL (service quality) methodology were tested for the three private eye care hospitals by using Analytical hierarchy process (AHP) in obtaining priority criteria; we found the most concerned dimension of service quality.

Adoption of Six Sigma’s DMAIC to Reduce Complications in IntraLase Surgeries

Purpose: To show how a private eye care center in Turkey initiated Six Sigma principles to reduce the number of complications encountered during and after femtosecond laser-assisted LASIK (IntraLase) surgeries. Method: Data were collected for five years. To analyse the complications among 448 surgeries, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) improvement cycle such as SIPOC table, Fishbone Diagram and, Failure, Mode and Effect Analysis were implemented. Sources and root causes of seventeen types of complications were identified and reported. Results: For a successful IntraLase surgery, experience of the refractive surgeon, patient’s anatomy and calibration of laser power were determined to be the “critical few” factors whereas, patient’s psychology, sterilization and hygiene, and suction-ring’s pressure were found to be the “trivial many” factors. The most frequently occurring complication was found to be subconjunctival haemorrhage. Conclusion: The process sigma level of the process was measured to be 3.3547. The surgical team concluded that sixteen complications (out of seventeen) should be significantly reduced by taking the necessary preventive measures.

Prevalence of spectacles use in Andhra Pradesh, India: Rapid Assessment of Visual Impairment project

To assess the prevalence and patterns of spectacles use in South India state of Andhra Pradesh. A population-based cross sectional study. Seven thousand eight hundred subjects aged ≥40 years, sampled from one urban and two locations. Two-stage cluster random sampling method was used to enumerate 7800 subjects. Distance visual acuity and near vision were assessed. A questionnaire was used to collect information on current and previous use of spectacles, spectacles providers and type of spectacles. Among those who discontinued use of spectacles, the reasons were elicited. The prevalence of spectacles use and spectacle coverage. In total, 7378/7800 subjects (95.0%) were examined. Among those examined, 53.6% were female, 49.5% of them aged between 40 and 49 years, and 62% of them had no education. The overall prevalence of spectacles use was 29.5% (95% confidence interval 28.5-30.4), 30.3% (95% confidence interval 29.0-31.6) in rural area compared with 27.9% (95% confidence interval 26.1-29.7) (P < 0.05) in urban location. Bifocals (72.8%) were the most common type of spectacles. Private eye clinics were the leading spectacles provider in all three regions. On applying multiple logistic regression, the odds of spectacles use increased with increasing age and were significantly higher for rural residents and those with higher levels of education. The spectacle coverage was 38.0% and 27% for refractive errors and presbyopia, respectively. Although prevalence of spectacles use is moderate, the spectacle coverage for both refractive errors and presbyopia is low. The strategies are required to improve the spectacle coverage in the region.