White British Patients Research Articles

PTU-019 Pain, perception and reality – comparison of comfort scores of south asian and white british patients undergoing bowel cancer screening colonoscopy:

<h3>Introduction</h3> There have been several studies suggesting South Asian patients have differing pain perception to White British patients.¹Watson <i><i>et al</i>.</i>compared hot and cold pain perception in 20 age-matched South Asian and White British volunteers, with significantly increased heat pain scores and reduced pain threshold.² Recently, Al-Hashimi <i><i>et al</i></i>showed no significant differences in post-operative pain scores and analgesia consumption in 60 South Asian patients undergoing total abdominal hysterectomy versus 60 age-matched White British controls.³ Sedation and analgesia administration is well regulated in colonoscopy practice and comparing comfort scores in similar aged South Asian and White British screening patients is of interest to bowel cancer screening programme (BCSP) centres in ethnically diverse areas. <h3>Method</h3> In 2014, colonoscopy screened individuals (BCSP) in Leicester and Kettering had their self-selected ethnic origin recorded. Comfort scores of 713 patients recorded in the Exeter online database was correlated to ethnic origin data and analysed. <h3>Results</h3> Total number of patients: 713 Difference between means: 0.26 (95% CI: 0.05–0.47) <h3>Conclusion</h3> This analysis shows mean comfort scores are significantly <i>lower</i>in South Asian patients (p = &lt;0.02). This is counter to what published literature might suggest. We reported in 2014 that South Asian patients undergoing BCSP colonoscopy have significantly lower adenoma detection rates when compared to White British patients (31.68% vs 48.09% p = &lt;0.02). ⁴Perhaps fewer adenomas requiring polypectomy lead to more straightforward colonoscopy and lower comfort scores. Whatever the explanation, this analysis shows that pain perception is complex. The interaction of patient ethnicity factors (behavioural, cultural, social and psychological) are not easily predicted and requires further study. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Edwards CL, Fillingim RB, Keefe F. Race, ethnicity and pain. Pain 2001; 94: 133–137 Watson PJ, Latif RK, Rowbotham DJ. Ethnic differences in thermal pain responses: a comparison of South Asian and White British healthy males. Pain 2005;118:194–200 Al-Hashimi M, Scott S, Griffin-Teall N, Thompson J. Influence of ethnicity on the perception and treatment of early post-operative pain. Pain 2014. doi: 10.1177/2049463714559254 Verma AM, Lewin V, Chilton AP, de Caestecker J, Dixon A, Jameson J, Wurm P, Robinson RJ. Variations in adenoma detection rate and cancer detection rate in individuals from different ethnic groups undergoing bowel cancer screening colonoscopy. Gut 2014;<b>63</b>(Suppl 1):A122

OC-088 Risk of oesophageal neoplasia in barrett’s oesophagus with indefinite for dysplasia or low grade dysplasia at index biopsy: a 10-year cohort study

Introduction Barrett’s oesophagus (BO) is the only recognised precursor for oesophageal adenocarcinoma (OAC). Accurate prediction of progression to high grade dysplasia (HGD) or OAC is important. The literature reports progression rates for indefinite for dysplasia (IND) at 1.2% per patient-year and low grade dysplasia (LGD) at 9% per patient-year. Our study aims to determine incidence of HGD or OAC in patients with confirmed histopathological diagnosis of IND or LGD at index biopsy. Method Retrospective review of all patients diagnosed with IND or LGD over a 10-year period from January 2003 to September 2014. Two specialist pathologists in Barrett’s oesophagus and neoplasia reviewed all histology. Primary end point was progression to HGD or OAC. Patient demographics and grade of endoscopist were recorded. Patients with HGD or OAC at index biopsy were excluded. Results 85 patients (78.8% male, 100% White British) had LGD; 138 (65.9% males, 100% White British) patients had IND. 47% (n = 40) patients with LGD and 10.1% (n = 14) patients with IND progressed to HGD or OAC in the 10-year period. Median age at progression was 71 years (IQR 61.5 to 75.3) and 68 years (IQR 60.25 to 73.5) for LGD and IND, respectively. Median time of progression from first diagnosis to HGD or OAC was 16 months for both IND and LGD. Median BO length was 7 cm (IQR 5 to 9.75) in LGD and 6 cm (IQR 4.25 to 6.75) in IND. 35% (n = 14) patients with LGD who progressed had an expert upper GI endoscopist performing the endoscopy; in these 14 patients, median time for progression was 5.5 months (IQR 3.25 to 12.75). 67.5% (n = 27) patients with LGD were diagnosed with HGD or OAC 12 months after their last biopsy; the median time to biopsy in the LGD group was 5 months (IQR 1.5 to 6). But 16.8% (n = 15) patients were diagnosed with HGD/OAC at the first follow-up biopsy; the median time to this diagnosis was 5 months (IQR 2.5 to 6). Excluding 5 IND patients who developed OAC within 12 months, median time to progression for IND was 46 months (IQR 18 to 66); 7 patients with IND progressed to HGD, 5 patients progressed to intramucosal adenocarcinoma, and 2 died of inoperable adenocarcinoma. Conclusion The majority of LGD who progressed occurred in less than 12 months, and median time to diagnosis was 5 months. An expert upper GI endoscopist follow up is warranted for earlier diagnosis and treatment in IND and LGD. Current BSG Guidelines suggest a follow-up surveillance endoscopy should be done at 6 months for confirmed LGD prior to radio-frequency ablation. Our findings suggest these patients should be followed up earlier. LGD should be recognised as a marker of more advanced neoplasia. Disclosure of interest None Declared.

Does the availability of a South Asian language in practices improve reports of doctor-patient communication from South Asian patients? Cross sectional analysis of a national patient survey in English general practices.

BackgroundEthnic minorities report poorer evaluations of primary health care compared to White British patients. Emerging evidence suggests that when a doctor and patient share ethnicity and/or language this is associated with more positive reports of patient experience. Whether this is true for adults in English general practices remains to be explored.MethodsWe analysed data from the 2010/2011 English General Practice Patient Survey, which were linked to data from the NHS Choices website to identify languages which were available at the practice. Our analysis was restricted to single-handed practices and included 190,582 patients across 1,068 practices. Including only single-handed practices enabled us to attribute, more accurately, reported patient experience to the languages that were listed as being available. We also carried out sensitivity analyses in multi-doctor practices.We created a composite score on a 0-100 scale from seven survey items assessing doctor-patient communication. Mixed-effect linear regression models were used to examine how differences in reported experience of doctor communication between patients of different self-reported ethnicities varied according to whether a South Asian language concordant with their ethnicity was available in their practice. Models were adjusted for patient characteristics and a random effect for practice.ResultsAvailability of a concordant language had the largest effect on communication ratings for Bangladeshis and the least for Indian respondents (p < 0.01). Bangladeshi, Pakistani and Indian respondents on average reported poorer communication than White British respondents [-2.9 (95%CI -4.2, -1.6), -1.9 (95%CI -2.6, -1.2) and -1.9 (95%CI -2.5, -1.4), respectively]. However, in practices where a concordant language was offered, the experience reported by Pakistani patients was not substantially worse than that reported by White British patients (-0.2, 95%CI -1.5,+1.0), and in the case of Bangladeshi patients was potentially much better (+4.5, 95%CI -1.0,+10.1). This contrasts with a worse experience reported among Bangladeshi (-3.3, 95%CI -4.6, -2.0) and Pakistani (-2.7, 95%CI -3.6, -1.9) respondents when a concordant language was not offered.ConclusionsSubstantial differences in reported patient experience exist between ethnic groups. Our results suggest that patient experience among Bangladeshis and Pakistanis is improved where the practice offers a language that is concordant with the patient’s ethnicity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0270-5) contains supplementary material, which is available to authorized users.

Management of depression in the British South Asian and British White patients with long-term conditions in primary care: A cross sectional study

Depression and pain dimensions in the assessment of healthrelated quality of life in older adults A.F. Allaz, C. Luthy, F. Herrmann, C. Ludwig, C. Cedraschi Division of General Medical Rehabilitation Beau-Sejour, SMIRG, University Hospital, Geneva, Switzerland, Division of Geriatric, University Hospitals Geneva, Switzerland, School of Health, University of Applied Sciences of Western Switzerland, Geneva, Switzerland

Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness.

Black and minority ethnic (BME) people using psychiatric services are at greater risk of non-engagement, dropout from care and not receiving evidence-based interventions than white British people. To identify effective interventions designed to improve therapeutic communications (TCs) for BME patients using psychiatric services in the UK, to identify gaps in the research literature and to recommend future research. Black African, black Caribbean, black British, white British, Pakistani and Bangladeshi patients in psychiatric services in the UK, or recruited from the community to enter psychiatric care. Some studies from the USA included Hispanic, Latino, Chinese, Vietnamese, Cambodian and African American people. Any that improve TCs between BME patients and staff in psychiatric services. The published literature, 'grey' literature, an expert survey, and patients' and carers' perspectives on the evidence base. Databases were searched from their inception to 4 February 2013. Databases included MEDLINE, Applied Social Sciences Index and Abstracts, The Cochrane Library, Social Science Citation Index, Allied and Complementary Medicine Database, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, EMBASE, The Campbell Collaboration and ProQuest for dissertations. Studies were included if they reported evaluation data about interventions designed to improve therapeutic outcomes by improving communication between BME patients and psychiatric professionals. Qualitative studies and reports in the grey literature were included only if they gave a critical evaluative statement. Two members of the team selected studies against pre-established criteria and any differences were resolved by consensus or by a third reviewer, if necessary. Data were extracted independently by two people and summarised in tables by specific study designs. Studies were subjected to a narrative synthesis that included a thematic analysis contrasting populations, countries and the strength of evidence for any intervention. The components of the interventions were compared. Patient perspectives on acceptability were considered alongside quality scores and methodological strengths and weaknesses. Twenty-one studies (19 from the published literature and two from the grey literature) met the inclusion criteria. There were 12 trials, two observational quantitative studies, three case series, a qualitative study and three descriptive case studies. Only two studies, one a pilot trial and one a case series, included economic data; in both, a favourable but weak economic case could be made for the intervention. The trials tested interventions to prepare patients for therapeutic interventions, variable levels of ethnic matching (of professional to patient), cultural adaptation of therapies, and interventions that included social community systems in order to facilitate access to services. Empowering interventions favoured by patients and carers included adapted cognitive-behavioural therapy, assessments of explanatory models, cultural consultation, ethnographic and motivational interviews, and a telepsychiatry intervention. Studies tended to have small sample sizes or to be pilot studies, and to use proxy rather than direct measures for TCs. Empowering interventions should be further researched and brought to the attention of commissioners. Several promising interventions need further evaluative research and economic evaluations are needed. The study is registered as PROSPERO CRD42011001661. The National Institute for Health Research Health Technology Assessment programme.

Palliative care experiences of adult cancer patients from ethnocultural groups: a qualitative systematic review protocol.

Review question/objective The objective of this review is to synthesize the best available evidence on palliative care experiences of adult cancer patients from ethnocultural groups. More specifically, this systematic review seeks to answer the following questions: 1. What are the palliative care experiences of adult cancer patients from diverse ethnocultural groups? 2. What meanings do adult patients with cancer from diverse ethnocultural groups assign to their experiences with palliative care? Inclusion criteria Types of participants This qualitative systematic review will consider studies that include adult cancer patients from ethnocultural groups whose ethnicity differs from that of the main population in the country of care, with inclusion of studies that compare experiences of under-represented groups with main groups in the country of care. Types of phenomena of interest The phenomenon of interest is the experience of palliative health care. Context The context for this review will be adult patients with a diagnosis of cancer who are receiving palliative care and are from different ethnocultural groups.

Influence of ethnicity on the perception and treatment of early post-operative pain.

Previous studies indicated that patients from Black, Asian and minority ethnic (BAME) groups tend to receive less analgesics compared to Caucasian (White) patients after similar surgical procedures. Most such data originated from North America and suggested that health-care professionals may perceive the expression of excessive pain by BAME patient groups as an exaggerated response to pain, rather than sub-optimal treatment. There are limited data comparing acute pain management between South Asian and White British patients. We aimed to investigate correlation between patients' ethnicity and disparities of early post-operative pain perception/management, in an ethnically diverse population. We conducted a retrospective case note review of acute post-operative pain after total abdominal hysterectomy (TAH) in 60 South Asian and 60 age-matched White British females. Data for 140 variables (pre-, intra- and post-operative) for each patient were recorded. We used propensity score matching to produce 30 closely matched patients in each group minimizing effects of recorded co-variates. Data were analysed with and without propensity score matching. There were no significant differences in acute post-operative pain scores, morphine requirements, pain management, adverse effects or duration of post-operative care unit stay between South Asian and White British patients. The median duration of hospital stay of South Asian patients was longer (4.5 days versus 3.0 days, p < 0.001). We conclude that in an institution where both patients and health-care professionals are from an ethnically diverse population, neither post-operative pain nor pain management are influenced significantly by South Asian ethnicity.

Ethnic variations in compulsory detention and hospital admission for psychosis across four UK Early Intervention Services.

BackgroundSubstantial ethnic variations have been found in incidence, pathways to care and outcomes in psychosis. It is unknown whether these remain as marked in the presence of specialist Early Intervention Services (EIS) for psychosis. We present the first UK study exploring ethnic differences in compulsory detention and hospitalization rates for EIS patients. We investigated whether the excess rates of compulsory admission for people from Black groups have persisted following nationwide introduction of EIS. We also explored variations in compulsory admission for other ethnic groups, and differences by gender and diagnosis.MethodsFour inner-city London EIS teams gathered data from first-presentation psychosis patients between 2004–2009 using the MiData audit tool. Clinical, sociodemographic and pathways to care data were recorded regarding adult patients from eight different ethnic groups at entry to EIS and one year later.ResultsBlack African EIS service users had odds of being detained and of being hospitalised three times greater than White British patients, even after adjustment for confounders. This was most marked in Black African women (seven to eight times greater odds than White British women). A post-hoc analysis showed that pathways to care and help-seeking behaviour partially explained these differences.ConclusionThese findings suggest EIS input in its current form has little impact on higher admission and detention rates in certain Black and minority groups. There is a need to tackle these differences and engage patients earlier, focusing on the needs of men and women from the most persistently affected groups.

Comparisons of Costs between Black Caribbean and White British Patients with Advanced Multiple Sclerosis in the UK

Background. Multiple sclerosis (MS) is now more common among black and minority ethnic groups in the UK but little is known about the costs of care amongst different ethnic groups. Objective. This study examined and compared service use and costs for people severely affected with MS from Black Caribbean (BC) and White British (WB) backgrounds in the UK and identified predictors of cost for both groups. Method. Population-based cross-sectional study of 43 BC and 43 WB patients with MS (EDSS ≥ 6) and their informal caregivers recruited from an MS service in southeast London. Interviews collected data on health and social service use and informal care support. Costs were calculated using UK unit cost data. Using regression analyses we compared costs between the ethnic groups and identified possible predictors of cost. Results. The mean (SD) costs for the WB and BC groups were £25,778 (£39,387) and £23,186 (£30,433), respectively. Results identified no significant difference in total cost between the two ethnic groups. The EDSS score alone was a significant predictor of cost. Conclusion. Similar costs between ethnic groups indicate that with regard to this MS service and geographical area, access to care was not affected by ethnicity.

Prognostic factors in pemphigus vulgaris and pemphigus foliaceus

Pemphigus typically has a chronic course, although there is great variability in disease duration (DD) and time taken to disease remission (DR) between individuals with the disease. The reasons for this are unclear. To explore the prognostic influence of epidemiological, clinical, immunological and genetic factors on disease course and remission in pemphigus vulgaris (PV) and pemphigus foliaceus (PF). This was a retrospective study of patients with PV and PF, recruited from a single UK centre. Direct and indirect immunofluorescence and enzyme-linked immunosorbent assay studies for antidesmoglein (Dsg) antibodies were used to assess immunological factors. Polymerase chain reaction with sequence specific primers (PCR-SSP) was used to assess the Class II human leukocyte antigen status of patients. Prognostic endpoints investigated were time to initial first DR and total DD. Ninety-five patients were recruited (79 PV and 16 PF). Patients of Indo-Asian origin were significantly associated with longer DD than White-British patients (P = 0.029). In addition, younger age at onset was associated with a worse prognosis in terms of DD: the mean age at presentation of patients with DD of < 5 years was 49 years (SEM = 3.4) compared with 40 years (SEM = 1.9) in those with DD > 5 years (P = 0.039). A higher initial intercellular antibody titre on normal human skin substrate was associated with a greater time to initial DR (P = 0.007) and high anti-Dsg 3 levels at baseline were associated with a longer total DD (P = 0.03). Ethnic group, age at presentation, initial intercellular antibody titre and initial Dsg 3 antibody levels all had a significant impact on prognosis of pemphigus.

Ethnic differences and socio-demographic predictors of illness perceptions, self-management, and metabolic control of type 2 diabetes

ObjectivesThis study investigated ethnic differences in diabetes-specific knowledge, illness perceptions, self-management, and metabolic control among black-African, black-Caribbean,and white-British populations with type 2 diabetes. The study also examined associations between demographic/disease characteristics and diabetes-specific knowledge, illness perceptions, self-management, and metabolic control in each of the three ethnic groups.DesignCross-sectionalSettingDiabetes/retinal screening clinics in Hackney and Brent, London.MethodsBlack-African, black-Caribbean and white-British populations with type 2 diabetes were asked to participate. Questionnaires measuring demographic/disease characteristics, diabetes-specific knowledge, self-management, and illness perceptions were used for data collection. Data for glycated hemoglobin (HbA1c) and microvascular complications were obtained from medical records. Ethnic differences in diabetes-related measures were estimated using analysis of variance/covariance. Multiple regression techniques were used to determine relationships between demographic/disease characteristics and measured diabetes-related outcomes.ResultsThree hundred and fifty-nine patients participated in the study. White-British participants had high diabetes-specific knowledge compared to their black-African and black-Caribbean counterparts. Black-Africans reported better adherence to self-management recommendations than the other ethnic groups. Compared to the white-British patients, black-African and black-Caribbean participants perceived diabetes as a benign condition that could be cured. Educational status and treatment category were determinants of diabetes-specific knowledge in all three ethnic groups. However, different demographic/disease characteristics predicted adherence to self-management recommendations in each ethnic group.ConclusionClearly, there is disease (diabetes) knowledge-perception variation between different ethnic groups in the UK which may partly influence overall disease outcome. It is plausible to recommend screening, identifying, and dispelling misconceptions about diabetes among ethnic minority patients by health care professionals as well as emphasizing the importance of self-management in managing chronic diseases such as diabetes.

Are depressive symptoms more common among British South Asian patients compared with British White patients with cancer? A cross-sectional survey

ObjectivesThis cross-sectional survey investigated whether there were ethnic differences in depressive symptoms among British South Asian (BSA) patients with cancer compared with British White (BW) patients during 9 months following...

Exploring the cultural validity of rheumatology outcomes

In rheumatoid arthritis (RA), the use of a 'core' set of treatment outcomes was pioneered to ensure that the same outcomes are measured across all clinical trials to enable comparison of trial results. However, studies have not investigated the influence of patients' ethnic and cultural backgrounds on treatment outcomes. This pilot study identified 74 treatment outcomes from female Punjabi RA patients, including 21 new ones that were not identified in previous research with white British RA patients. The social impact of RA created significant additional burden for these Punjabi women, with 'less stigmatisation' and 'improved ability to carry out family duties' generated as important new outcomes. This study illustrates a need to address cultural validity in outcome elicitation and prioritisation, to ensure that interventions are evaluated using criteria that have meaning for people with that condition.

Effect of financial incentives on ethnic disparities in smoking cessation interventions in primary care: cross-sectional study

Smoking cessation interventions are underprovided in primary care. Financial incentives may help address this. However, few studies in the UK have examined their impact on disparities in the delivery of smoking cessation interventions. Cross-sectional study using 2007 data from 29 general practices in Wandsworth, London, UK. We used logistic regression to examine associations between disease group [cardiovascular disease (CVD), respiratory disease, depression or none of these diseases], ethnicity and smoking outcomes following the introduction of the Quality and Outcomes Framework in 2004. Significantly, more CVD patients had smoking status ascertained compared with those with respiratory disease (89 versus 72%), but both groups received similar levels of cessation advice (93 and 89%). Patients with depression or none of the diseases were less likely to have smoking status ascertained (60% for both groups) or to receive advice (80 and 75%). Smoking prevalence was high, especially for patients with depression (44%). White British patients had higher rates of smoking than most ethnic groups, but black Caribbean men with depression had the highest smoking prevalence (62%). Smoking rates remain high, particularly for white British and black Caribbean patients. Extending financial incentives to include recording of ethnicity and rewarding quit rates may further improve smoking cessation outcomes in primary care.

Meanings of happiness among two ethnic groups living with advanced cancer in south London: a qualitative study

Happiness is a central component in quality of life but little is known about its meanings among people living with an advanced disease and those from diverse communities. This study explores and compares, for the first time, the centrality and interpretations of happiness across two cultural groups living with advanced cancer. Semi-structured interviews among 26 Black Caribbean and 19 White British cancer patients were conducted in hospital and home settings. Thirty eight participants volunteered views on happiness, which were related to four main themes: empty lives, a theme associated with lives devoid of contentment; happiness and the physical form principally, associated with the absence of distressing symptoms; 'love and affection' associated with family and friends; and 'realising personal meaning in life', most common among the Black Caribbean participants and related to God, prayer and the sacred world. The presence of cancer pain even when refractory did not preclude manifestations of happiness in this domain. We identified that happiness was central to many patients' quality of life during advanced cancer. Moreover, happiness was multidimensional and at times culturally patterned. We recommend that health and social care professionals increase their awareness and skills-set in relation to exploring happiness. Further, we recommend greater efforts are invested in cultural relativism to service the physical, psychological, social and spiritual issues that contribute towards moments of happiness among diverse communities.

A common variant in the PTPN11 gene contributes to the risk of tetralogy of Fallot.

Tetralogy of Fallot (TOF) is the commonest cyanotic form of congenital heart disease. In 80% of cases, TOF behaves as a complex genetic condition exhibiting significant heritability. As yet, no common genetic variants influencing TOF risk have been robustly identified. Two hundred and seven haplotype-tagging single nucleotide polymorphisms in 22 candidate genes were genotyped in a test cohort comprising 362 nonsyndromic British white patients with TOF together with 717 unaffected parents of patients and 183 unrelated healthy controls. Single nucleotide polymorphisms with suggestive evidence of association in the test cohort (P<0.01) were taken forward for genotyping in an independent replication cohort comprising 392 cases of TOF, 218 unaffected parents of patients, and 1319 controls. Significant association was observed for 1 single nucleotide polymorphism, rs11066320 in the PTPN11 gene, in both the test and the replication cohort. Genotype at rs11066320 was associated with a per-allele odds ratio of 1.34 (95% confidence interval [CI], 1.19 to 1.52; P=2.9 × 10(-6)) in the total cohort of TOF cases and controls; this remained highly significant after Bonferroni correction for 207 analyses (corrected P=0.00061). Genotype at rs11066320 was responsible for a population-attributable risk of TOF of approximately 10%. Common variation in the linkage disequilibrium block including the PTPN11 gene contributes to the risk of nonsyndromic TOF. Rare mutations in PTPN11 are known to cause the autosomal dominant condition Noonan syndrome, which includes congenital heart disease, by upregulating Ras/mitogen-activated protein kinase (MAPK) signaling. Our results suggest a role for milder perturbations in PTPN11 function in sporadic, nonsyndromic congenital heart disease.

The social difficulties of cancer patients of South Asian Indian and Pakistani origin: a cross-sectional questionnaire and interview study

ObjectivesTo evaluate, in a sample of patients of South Asian (SA) origin, the acceptability of introducing assessment of social difficulties in everyday practice, examine the range and severity of reported...

The prevalence of abnormal hepatic biochemistry and hepatobiliary morbidity in a cohort of patients with inflammatory bowel disease

IntroductionThere is a recognised association between Inflammatory Bowel Disease (IBD) and both abnormal hepatic biochemistry and hepatobiliary morbidity. Hepatic steatosis, primary sclerosing cholangitis (PSC), cholelithiasis and drug reactions have all...

The social difficulties of cancer patients of South Asian Indian and Pakistani origin

IntroductionCancer patients experience psychosocial and informant needs. The National Cancer Survivorship Initiative recommends a shift towards assessment, information provision, personalised care planning and support for self-management including assessment within the...

Patterns of refractive change in myopic subjects during the incipient phase of presbyopia: a preliminary study

Changes in refractive error are well documented over the typical human lifespan. However, a relatively neglected period of investigation appears to be during the late fourth decade; this is at the incipient phase of presbyopia (IP), where the amplitude of accommodation is much reduced and approaches the level where a first reading addition is anticipated. Significantly, informal clinical observation has suggested a low incidence of an unexpected abrupt increase in myopia during IP. We investigated this alleged myopic shift retrospectively by mapping the longitudinal refraction histories of normally-sighted 35-44 years old British White patients previously examined in routine optometric practice. The refractive trends in the right eyes of healthy myopic subjects (spherical equivalent refraction, SER ≤-0.50 D: N=39) were analysed relative to that point at which a first near dioptric addition was considered to be clinically useful. A refractive change was evident in some subjects during IP; viz, an abrupt increase in myopic SER of between -0.50 and -0.75 D. These individuals (N=8) represented 20% of the study population of myopic incipient presbyopes. Beyond the pivotal point of the first near addition the longitudinal refraction stabilized in these subjects. In contrast, and as the extent of the available longitudinal data would permit, the remaining myopic eyes maintained an approximately stable refractive trend throughout IP and beyond. The anatomical or physiological basis of this specific late (non-developmental) abrupt myopic refractive change is an intriguing issue. Axial (vitreous chamber elongation), corneal (contour) and lenticular (profile and index) power bases, alone or in concert, might be considered candidates for this hitherto unexplored refractive phenomenon. Although necessarily obtained under conventional conditions of central (0 deg) fixation, our data might also be a reflection of the recent recognition of the possible influence of the peripheral refraction upon the axial error. Consideration of this material provides an impetus for further research, including ocular biometry, a reappraisal of ciliary zonular functional anatomy, renewed investigation of the AC/A ratio, and the extent of a centripetal refractive influence on myopia development.