ORCID Profile
0000-0002-6745-6411
Current Organisations
Johns Hopkins Hospital
,
Save Sight Institute / University of Sydney
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Publisher: SAGE Publications
Date: 16-09-2020
Abstract: Endoscopic dacryocystorhinostomy (EN-DCR) is an increasingly common procedure performed by otolaryngologists. While EN-DCR has a high rate of success at relieving blockage of the lacrimal system, little is known regarding associated postoperative infection (POI) rates and risk factors. The purpose of this study was to identify factors associated with the occurrence of postoperative orbital and rhinologic infection in a large cohort of patients undergoing EN-DCR. A retrospective review of 582 patients who underwent EN-DCR was performed. All patients received antibiotic prophylaxis as a single intraoperative intravenous administration and a ten-day postoperative oral course. Clinical and demographic information was reviewed, including the occurrence of acute orbital or rhinologic infection within 30 days of surgery. Multivariable analysis was performed to identify risk factors associated with POI. Fifteen of 582 patients (2.6%) developed POI following EN-DCR. The most common POI was acute rhinosinusitis (10/15, 66.7%), followed by acute dacryocystitis (2/15, 13.3%), preseptal cellulitis (2/15,13.3%), and acute bacterial conjunctivitis (1/15, 6.7%). The majority of patients (464/582, 79.7%) underwent concurrent endoscopic sinus surgery (ESS). In most cases (302/464, 65.1%), ESS was performed to address comorbid rhinosinusitis, whereas 7.8% (36/464) of patients underwent surgery to enhance surgical access to the lacrimal sac. Patients who underwent concurrent ESS were less likely to develop POI (OR: 0.17, CI: 0.04-0.80, p 0.05). Evidence of mucopurulence at surgery increased the likelihood of POI (OR: 6.24, CI: 1.51-25.84, p 0.05). Mucopurulence at the time of surgery significantly increased the risk of POI, whereas concurrent ESS, performed most commonly to address comorbid rhinosinusitis, significantly decreased the risk of POI. Awareness of risk factors for POI and appropriate surgical management of concurrent rhinosinusitis can lead to reduced infectious complications after EN-DCR.
Publisher: Elsevier BV
Date: 11-2022
Publisher: Elsevier BV
Date: 02-2022
Publisher: BMJ
Date: 30-03-2021
DOI: 10.1136/BJOPHTHALMOL-2020-317547
Abstract: We set out to identify risk factors for progression in untreated keratoconus patients from 34 centres across Australia, New Zealand, Spain and Italy. Patients were ided into ‘progressors’ and ‘stable’ patients for each clinical parameter: visual acuity (VA), steepest keratometry (maximum keratometry (Max-K)) and thinnest corneal thickness (TCT). Primary outcomes were the proportion of eyes with sustained progression in VA, Max-K or TCT within 3 years. Secondary outcomes included predictors of progression. There were 3994 untreated eyes from 2283 patients. The proportion of eyes with VA, Max-K and TCT progression at 1 year were 3.2%, 6.6% and 3.1% respectively. Factors associated with VA loss were higher baseline VA (HR 1.15 per logMAR line increase in VA p .001) and steeper baseline Max-K (HR 1.07 per 1D increase p .001). Younger baseline age was associated with Max-K steepening (HR 0.96 per year older p=0.001). Thicker baseline TCT, steeper baseline Max-K and younger baseline age were associated with TCT thinning: (HR 1.08 per 10 µm increase in TCT p .001), (HR 1.03 per 1D increase p=0.02) and (HR 0.98 per year younger p=0.01), respectively. Steeper Max-K and younger age were the most clinically useful baseline predictors of progression as they were associated with worsening of two clinical parameters. Every 1D steeper Max-K was associated with a 7% and 3% greater risk of worsening VA and thinning TCT, respectively. Each 1 year younger was associated with a 4% and 2% greater risk of steepening Max-K and thinning TCT, respectively.
Publisher: Wiley
Date: 28-05-2023
DOI: 10.1111/CEO.14260
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 05-2023
Publisher: Elsevier BV
Date: 2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-12-2022
Publisher: Elsevier BV
Date: 10-2021
Publisher: Elsevier BV
Date: 03-2022
Publisher: Massachusetts Medical Society
Date: 23-11-2017
DOI: 10.1056/NEJMC1712573
Publisher: AOSIS
Date: 30-10-2019
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 28-04-2021
DOI: 10.1167/IOVS.62.5.2
Publisher: Elsevier BV
Date: 12-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-05-2023
DOI: 10.1097/ICO.0000000000003263
Abstract: The aim of this study was to investigate the impact of keratoconus on the mental health and emotional well-being of affected patients. A literature search was conducted according to the PRISMA guidelines. Databases searched included MEDLINE, PubMed, EMBASE, Scopus, Web of Science, Cochrane, and PsycINFO. Articles were included if they were a primary study that investigated mental health or emotional quality-of-life outcomes in patients with keratoconus. Thirty-one articles met inclusion criteria of a total yield of 444. Most studies reported keratoconus to have a negative effect on mental health or emotional well-being. Worsening mental health scores correlated with lower visual acuity (VA) in the better eye, lower VA in the worse eye, increasing ocular asymmetry, and worsening disease severity. Mental health impacts were often reported to be disproportionate to that of the effects on VA. Over time mental health outcomes improved, suggesting stabilization of disease and patient acceptance. Patients with keratoconus may suffer detriments to mental health despite having relatively good VA. Understanding and acceptance of their disease may assist in assuaging mental health concerns. Further work may be needed to investigate whether benefit exists in routine mental health screening of patients with keratoconus.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2017
DOI: 10.1097/OPX.0000000000001143
Abstract: This review has identified the best existing patient-reported outcome (PRO) instruments in refractive error. The article highlights the limitations of the existing instruments and discusses the way forward. A systematic review was conducted to identify the types of PROs used in refractive error, to determine the quality of the existing PRO instruments in terms of their psychometric properties, and to determine the limitations in the content of the existing PRO instruments. Articles describing a PRO instrument measuring 1 or more domains of quality of life in people with refractive error were identified by electronic searches on the MEDLINE, PubMed, Scopus, Web of Science, and Cochrane databases. The information on content development, psychometric properties, validity, reliability, and responsiveness of those PRO instruments was extracted from the selected articles. The analysis was done based on a comprehensive set of assessment criteria. One hundred forty-eight articles describing 47 PRO instruments in refractive error were included in the review. Most of the articles (99 [66.9%]) used refractive error–specific PRO instruments. The PRO instruments comprised 19 refractive, 12 vision but nonrefractive, and 16 generic PRO instruments. Only 17 PRO instruments were validated in refractive error populations six of them were developed using Rasch analysis. None of the PRO instruments has items across all domains of quality of life. The Quality of Life Impact of Refractive Correction, the Quality of Vision, and the Contact Lens Impact on Quality of Life have comparatively better quality with some limitations, compared with the other PRO instruments. This review describes the PRO instruments and informs the choice of an appropriate measure in refractive error. We identified need of a comprehensive and scientifically robust refractive error–specific PRO instrument. Item banking and computer-adaptive testing system can be the way to provide such an instrument.
Publisher: Informa UK Limited
Date: 07-2015
DOI: 10.1111/CXO.12286
Abstract: Uncorrected refractive error is a public health problem globally and in Nepal. Planning of refraction services is h ered by a paucity of data. This study was conducted to determine availability and distribution of human resources for refraction, their efficiency, the type and extent of their training the current service provision of refraction services and the unmet need in human resources for refraction in Central Nepal. This was a descriptive cross-sectional study. All refraction facilities in the Central Region were identified through an Internet search and interviews of key informants from the professional bodies and parent organisations of primary eye centres. A stratified simple random s ling technique was used to select 50 per cent of refraction facilities. The selected facilities were visited for primary data collection. Face-to-face interviews were conducted with the managers and the refractionists available in the facilities using a semi-structured questionnaire. Data was collected in 29 centres. All the managers (n=29 response rate 100 per cent) and 50 refractionists (Response rate 65.8 per cent) were interviewed. Optometrists and ophthalmic assistants were the main providers of refraction services (n=70, 92.11 per cent). They were unevenly distributed across the region, highly concentrated around urban areas. The median number of refractions per refractionist per year was 3,600 (IQR: 2,400 - 6,000). Interviewed refractionists stated that clients' knowledge, attitude and practice related factors such as lack of awareness of the need for refraction services and/or availability of existing services were the major barriers to the output of refraction services. The total number of refractions carried out in the Central Region per year was 653,176. An additional 170 refractionists would be needed to meet the unmet need of 1,323,234 refractions. The study findings demand a major effort to develop appropriately trained personnel when planning refraction services in the Central Region and in Nepal as a whole. The equitable distribution of the refractionists, their community-outreach services and awareness raising activities should be emphasised.
Publisher: African Journals Online (AJOL)
Date: 30-06-2020
DOI: 10.4314/MMJ.V32I2.2
Abstract: Background To assess the psychometric properties of the QIRC questionnaire and use it as an outcome measure in spectacle wearers attending an eye clinic in Malawi. MethodsParticipants who had uncorrected distance visual acuity of below 6/18 and improved to 6/9 or better with spectacles on both eyes were included in the study. The participants self-administered the Chichewa version of the QIRC questionnaire that was translated and culturally adapted for Malawian settings. Psychometric evaluation of the QIRC responses was carried out using the WinSteps software (Version 3.92.1 Winsteps, Chicago, IL) by applying the Andrich rating scale model of the Rasch analysis.Results One hundred and forty-three participants (mean age ± standard deviation, 27.64 ± 2.91 age range 16 to 39 years male, 51.7%) completed the QIRC. The Chichewa QIRC had satisfactory psychometric properties (Ordered response categories, Person separation index, 1.93 Item separation index, 3.42 Targeting 0.70) including excellent Rasch-model fit statistics (Infit and Outfit MnSq 1.30 for all items). The QIRC score was not significantly associated with sex, age, magnitude of refractive error, occupation and status of previous spectacle wear (p 0.05 for all). The QIRC scores negatively correlated with uncorrected visual acuity (in logMAR) in the better eye (spearman’s rho=-0.34, p 0.001).ConclusionsThe translated and culturally adapted version of the QIRC Questionnaire had satisfactory psychometric properties to measure the refractive error-specific quality of life in Malawi. It performed well as an outcome measure of spectacle wear. Key words: validation, quality of life, Rasch analysis, spectacles, Malawi
Publisher: Elsevier BV
Date: 07-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2022
DOI: 10.1097/APO.0000000000000555
Abstract: Keratoconus is a disorder that results in visual loss from increased corneal high-order aberrations and irregular astigmatism and reduces quality of life. The primary treatment for progressive keratoconus is crosslinking (CXL). Recently, it has been suggested that oxygen enhances the type II photodynamic reaction of CXL that is oxygen dependent. Our study investigated the effect of increased oxygen availability in epithelium-on CXL on visual acuity and corneal curvature. We searched PubMed, EMBASE, Medline, Web of Science, and Scopus databases on November 3, 2021. We included studies that reported increased oxygen availability during CXL in patients with keratoconus published within the last 10 years. A meta-analysis on the primary outcomes, maximum keratometry, and corrected distance visual acuity, was conducted. The search yielded 108 publications which were screened and assessed for eligibility. Six studies were included in the systematic review and 5 studies were included in our meta-analysis of the outcomes of increased oxygen availability in accelerated CXL. The meta-analysis on data after 6 months of follow-up found a significant decrease in mean maximum keratometry of 1.2 diopter (95% confidence interval: 0.2–2.3 P =0.02) and an improvement in mean corrected distance visual acuity by 0.08 logMAR (95% confidence interval, 0.02–0.13 P =0.01). There were no serious adverse events reported. Increasing oxygen during epithelium-on CXL improved visual acuity and produced corneal flattening without any serious adverse events in patients with keratoconus. The demarcation line depth was significantly higher with oxygen compared to the control group. Further data are required with a control group and long-term follow-up across a range of CXL protocols for implementation into standard clinical practice.
Publisher: SAGE Publications
Date: 09-2011
Abstract: The entire low vision patients’ file that underwent low vision examination in 2009 in two major eye hospitals was retrospectively reviewed. Out of 1547 cases, 1140 (73.69%) were male and 407 (26.31%) were female. The mean age of presentation was 31.04 ± 20.63 years, of which 89.1 percent were from a rural community, 39.10 percent had avoidable blindness. Refractive error and amblyopia (24%) and retinitis pigmentosa (22.4%) were the most common causes of low vision. Refractive error and amblyopia (30.33%), retinitis pigmentosa (29.03%) and age related macular degeneration (ARMD) (36.5%) were the major causes of low vision in 0—15, —60 and years age group respectively. The number of patients 1107 (71.55%) improved significantly with refractive correction. Eighty-eight (5.68%) were prescribed telescopes. For near vision, only 359 (23.2%) patients were prescribed magnifiers. There was a significant improvement of functional vision after provision of low vision devices, particularly for patients with residual vision better than 20/1200.
Publisher: Wiley
Date: 2021
DOI: 10.1002/TRC2.12200
Abstract: Dementia is currently one of the leading causes of mortality globally, and mortality due to dementia will likely increase in the future along with corresponding increases in population growth and population aging. However, large inconsistencies in coding practices in vital registration systems over time and between countries complicate the estimation of global dementia mortality. We meta‐analyzed the excess risk of death in those with dementia and multiplied these estimates by the proportion of dementia deaths occurring in those with severe, end‐stage disease to calculate the total number of deaths that could be attributed to dementia. We estimated that there were 1.62 million (95% uncertainty interval [UI]: 0.41–4.21) deaths globally due to dementia in 2019. More dementia deaths occurred in women (1.06 million [0.27–2.71]) than men (0.56 million [0.14–1.51]), largely but not entirely due to the higher life expectancy in women (age‐standardized female‐to‐male ratio 1.19 [1.10–1.26]). Due to population aging, there was a large increase in all‐age mortality rates from dementia between 1990 and 2019 (100.1% [89.1–117.5]). In 2019, deaths due to dementia ranked seventh globally in all ages and fourth among in iduals 70 and older compared to deaths from other diseases estimated in the Global Burden of Disease (GBD) study. Mortality due to dementia represents a substantial global burden, and is expected to continue to grow into the future as an older, aging population expands globally.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Springer Science and Business Media LLC
Date: 26-09-2021
DOI: 10.1007/S10103-021-03420-Z
Abstract: Refractive errors are the most common causes of vision impairment worldwide and laser refractive surgery is one of the most frequently performed ocular surgeries. Clinical studies have reported that approximately 10.5% of patients need an additional procedure after the surgery. The major complications of laser surgery are over/under correction and dry eye. An increase in temperature may be a cause for these complications. The purpose of this study was to estimate the increase in temperature during laser refractive surgery and its relationship with the complications observed for different surgical techniques. In this paper, a finite element model was applied to investigate the temperature distribution of the cornea when subjected to ArF excimer laser at a single spot using various beam delivery systems (broad beam, scanning slit, and flying spot). The Pennes bio-heat equation was used to predict the temperature values at different laser pulse energies and frequencies. The maximum temperature increase by ArF laser ([Formula: see text] frequency and [Formula: see text] pulse energy) at a single spot was [Formula: see text] for [Formula: see text] diopter correction ([Formula: see text] of ablation of corneal stroma) using broad beam, scanning slit, and flying spot beam delivery approaches respectively. The peak temperature due to a single pulse was estimated to be [Formula: see text]. Although the peak temperature (sufficient energy to break intermolecular bonds) exists for a very short time ([Formula: see text]) compared to the thermal relaxation time ([Formula: see text]), there is some thermal energy exchange between corneal tissues during a laser refractive surgery. Heating may cause collagen denaturation, collagen shrinkage, and more evaporation and hence proposed to be a risk factor for over/under correction and dry eye.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-11-2019
Publisher: Elsevier BV
Date: 04-2021
Publisher: Elsevier BV
Date: 02-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-05-2022
Publisher: Nepal Journals Online (JOL)
Date: 22-03-2017
DOI: 10.3126/NEPJOPH.V8I2.17021
Abstract: Blindness, which is a major burden on the in idual and the society, was observed to be pervasively present in a region inhabited by an undermined, disadvantaged ethnic people, the Chepang (Köberlein et al., 2013). Such a plight heralds escalating, already- fragile eye health care in the remote region of Nepal (Ghimire, 2015).
Publisher: Elsevier BV
Date: 08-2023
Publisher: Informa UK Limited
Date: 11-2014
DOI: 10.1111/CXO.12195
Abstract: This study sought to document current refractive services in the northern and central regions of Ghana as a first step toward evidence-based planning of refractive services. A descriptive cross-sectional survey was carried out in health facilities in the northern and central regions of Ghana, which provided eye-care services. A semi-structured questionnaire was administered to gather information on each facility type, human resources providing refractive services, assessment of refraction and spectacle dispensing output and provider barriers to the services. Current outputs of refraction in the northern and central regions were 0.5 and 1.2 per cent of the estimated refractive needs, respectively. Spectacle dispensing services were below the outputs of refraction. Lack of equipment (36.8 per cent) and cost of providing spectacles frames (31.6 per cent), were identified as the main barriers to providing refractive services. The provision of refractive services in the study regions was inadequate. Lack of infrastructure and inadequate human resource were the major reasons for the limited service provision. This should be considered for planning refractive services in the study regions and Ghana as a whole.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-04-2021
Publisher: Elsevier BV
Date: 03-2021
Publisher: Elsevier BV
Date: 04-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-08-2022
Publisher: Elsevier BV
Date: 12-2022
Publisher: Elsevier BV
Date: 04-2018
Publisher: Elsevier BV
Date: 2021
Publisher: American Medical Association (AMA)
Date: 03-2022
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.CLAE.2021.101521
Abstract: The aim of this review was to evaluate the evidence on quality-of-life outcomes of long-term contact lens wear. A search for original articles that used validated measures to evaluate patient-reported outcomes (PROs) in long-term (≥2 years) contact lens wearers was conducted in Medline Ovid, PubMed, Scopus, Web of Science, Cochrane, CINAHL, and PsycInfo databases. The information including PRO measure (name, type, content) and key quality-of-life outcomes findings were extracted. Seven articles that used 4 PRO measures to evaluate quality of life outcomes of long-term contact lens wear met the inclusion criteria. The median (range) number of contact lens wearers in these studies was 116 (31-247). The studies were conducted in 4 countries: USA, Spain, China, and Russia. All studies were conducted in myopic populations. None of the studies provided information on psychometric properties, validity and reliability of the PRO measures used. Five studies were conducted in children of which 3 studies evaluated PROs of myopia control contact lens wear. The studies reported that contact lens wear, including myopia control lens wear, was an effective method of refractive correction in children and adults in the long term in PRO-perspective, and resulted in a better quality of life status than with glasses. However, long-term dry eye and discomfort related symptoms were reported. Overall, contact lens use improved quality of life status in children and adults. More research is required to better understand the long-term quality-of-life outcomes of contact lens wear.
Publisher: Elsevier BV
Date: 08-2022
Publisher: Mary Ann Liebert Inc
Date: 04-2012
Abstract: Aim of the study was to evaluate the effects of ethambutol therapy in visual functions. Prospective evaluation of 88 eyes of 44 patients on ethambutol therapy under Directly Observed Treatment Short-course (category I) for primary tuberculosis was done before start of ethambutol therapy and after 2 months of starting the therapy. Parameters evaluated were visual acuity with Bailey Lovie Log-MAR chart, contrast sensitivity with Pelli-Robson contrast sensitivity chart, color vision with Farnsworth D15 test, visual fields with Octopus automated perimetry, and multifocal electroretinography (ERG) with Roland-RETI scan along with anterior and posterior segments evaluation. No visual functional defect was noted at baseline. On follow-up, color vision, visual field parameters, and anterior and posterior segment findings were not affected in any patients. Mean visual acuity before starting therapy was 0.00±0.08 Log-MAR and after therapy was 0.08±0.18 Log-MAR. Change in visual acuity was statistically significant (p=0.004). Difference between contrast sensitivity before and after therapy was statistically highly significant both monocularly and binocularly (p<0.005 in both cases). P1 litudes (in terms of nV/deg(2) and μV) of ERG waves were significantly reduced and their P1 latencies were significantly increased in all the rings after ethambutol therapy (p<0.05). There was no significant change in N1 litudes and N1 latencies after therapy in any of the rings. Visual acuity, contrast sensitivity, and multifocal ERG are sensitive tests to detect ethambutol toxicity in subclinical stages and hence very useful tools for monitoring patients under ethambutol therapy for ocular toxicity.
Publisher: Elsevier BV
Date: 09-2022
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 02-2022
Publisher: Wiley
Date: 07-02-2022
DOI: 10.1111/CEO.14050
Abstract: The objectives of this study were to evaluate the quality-of-life (QoL) impact of eye diseases (keratoconus neovascular age-related macular degeneration, AMD retinal vein occlusion, RVO and diabetic macular edema, DME) using the Impact of Vision Impairment (IVI) questionnaire, and to determine the relationship between the IVI scores and visual acuity. This cross-sectional, multicentre, real-world study utilised the prospective, web-based Save Sight Registries. The IVI was completed by 1557 patients: 307 with keratoconus, 1049 with AMD, 148 with RVO and 53 with DME. Statistical analysis included Rasch analysis, Welch t-test, one-way ANOVA, Tukey's test, Pearson correlation, and multiple regression. The IVI scales (Overall Visual Function, VF Emotional, EM) had robust psychometric properties. The keratoconus patients had the worst Overall (adjusted mean: 48.2 vs. DME 58.8, RVO 64.6, AMD 67.6 units), VF (47.7 vs. DME 59.4, RVO 65.9, AMD 68.9 units) and EM (50.8 vs. DME 63.1, RVO 69.2, AMD 71.8 units) scores (all p < 0.05). The IVI scales scores weakly correlated with better and worse eye visual acuity (Pearson's r 0.24-0.39, all p < 0.05). The correlations were similar in the better eye (Overall 0.35, VF 0.39, EM 0.24) and the worse eye (Overall 0.31, VF 0.33, EM 0.25) visual acuity. Correlations with visual acuity were stronger for VF than for the EM scores. The IVI was a psychometrically robust QoL questionnaire. Keratoconus patients had worse IVI scores than patients with retinal diseases. The low strength of correlations between visual acuity and QoL scores, although statistically significant, suggested that a complex relationship exists.
Publisher: Springer Science and Business Media LLC
Date: 27-06-2023
DOI: 10.1038/S41433-023-02641-6
Abstract: To compare long-term effectiveness of Standard (UV intensity: 3 mW/cm 2 , duration: 30 min) vs Accelerated (UV intensity: 9 mW/cm 2 , duration: 10 min) corneal cross-linking (CXL) for stabilising keratoconus. Data for this observational study were captured through a web-based registry system from the routine clinical practice (15 sites across Australia, New Zealand and Italy). The outcomes were compared using mixed-effects regression models. A total of 100 eyes (75 patients) who had standard CXL and 76 eyes (66 patients) who had accelerated CXL, with a follow-up visit at five-year post-CXL were included. Both CXL protocols were effective and safe in stabilising keratoconus and improving outcomes. The adjusted mean changes (95% CI) in outcomes were better in standard CXL than in accelerated CXL [visual acuity gain, 10.2 (7.9–12.5) vs 4.9 (1.6–8.2) logMAR letters pinhole visual acuity 5.7 (3.5–7.8) vs 0.2 (−2.2 to 2.5) logMAR letters Kmax −1.8 (−4.3 to 0.6) vs 1.2 (−1.5 to 3.9)D K2 −0.9 (–2.2 to 0.3) vs 0.1 (−1.3 to 1.6)D MCT –3.0 (−13.7 to 7.7) vs −11.8 (−23.9 to 0.4) µm ( p values for visual acuity, pinhole visual acuity, Kmax: .05 for K2 and MCT: .05)]. The frequency of adverse events at the 5-year follow-up visit was low in both groups [standard, 5 (5% haze 3 scarring 1, epithelial defect 1) and accelerated 3 (3.9% haze 2, scarring 1)]. Both standard and accelerated CXL were safe and effective procedures for stabilising keratoconus in the long term. The standard CXL resulted in greater improvements in visual acuity and keratometry.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2018
DOI: 10.1097/OPX.0000000000001246
Abstract: Existing patient-reported outcome instruments in refractive error are paper-based questionnaires. They are not comprehensive and psychometrically robust. This study has identified the content of the refractive error–specific item banks that aim to provide comprehensive and scientific measurement of refractive error–specific quality of life. The purpose of this study was to identify minimally representative, optimally informative, and efficient sets of items for measuring quality of life in people with refractive error. First, items were identified from existing patient-reported outcome instruments. Second, items were developed from qualitative studies with people with refractive error (48 and 101 in-depth interviews in Australia and Nepal, respectively). Third, classification and selection of items were done based on a set of systematic criteria using an iterative process of binning and winnowing. The resulting items underwent cognitive testing with people with refractive error in Australia and in Nepal. Each step was guided by an expert panel consensus. We retrieved 792 items from the existing patient-reported outcome instruments. From the interviews conducted in Australia, a total of 2367 comments were coded into 807 initial items. Similarly, from the interviews conducted in Nepal, 3477 comments were coded into 914 initial items. After binning and winnowing, followed by cognitive testing, a final set of items comprising 337 items for the Item-pool (Australia) and 308 items for the Item-pool (Nepal), both spanning 12 domains, was obtained. Forty-seven percent of items were common across the two item pools. In the Item-pool (Nepal), 65% items were common for corrected and uncorrected refractive error. We identified the content of two different sets of item banks to comprehensively measure the impact of refractive error on quality of life for people in Australia and Nepal, which may be applicable to high-income country settings and low- and middle-income country settings, respectively. Future work aims to develop computer-adaptive testing system to administer the item banks, resulting in useful measurement tools for researchers, clinicians, and policy planners.
Publisher: Informa UK Limited
Date: 2014
DOI: 10.1111/CXO.12069
Abstract: Significant levels of non-compliance and poor hygiene among contact lens wearers have been reported previously from different parts of the world. This survey aimed at identifying the scope of hygiene and non-compliant behaviour of soft contact lens wearers in the Mal es. Established soft lens wearers attending two eye clinics in Male' city, were interviewed in office or via telephone. A set of interviewer-administered questions was used to access the subjective response on compliance and hygiene behaviour (hand and lens case hygiene, water exposure, adherence to lens replacement schedule, dozing and overnight wear, awareness of aftercare visits and reuse of disinfecting solution). Participants were also asked to rate themselves as a contact lens user based on their perceived compliance and hygiene practices. Out of 107 participants, 79 (74.8 per cent) were interviewed in the office and the rest via telephone. The majority of lens wearers were female, office workers and students, with a mean age of 20.64 ± 4.4 years. Mean duration of lens wear was 28.04 ± 8.36 months. Most of them were using spherical lenses (86.9 per cent) on a daily wear basis (96.3 per cent). Major reported forms of non-compliance were poor hand hygiene (60.7 per cent), lack of aftercare awareness (39.3 per cent), water exposure (35.5 per cent) and over-use of lenses (24.3 per cent). While females were more likely to overuse their lenses than males (p < 0.005), other socio-demographic factors were not associated with reported non-compliance. Although around 90 per cent of the participants considered themselves average or good contact lens wearers, most exhibited some form of non-compliant and poor hygienic behaviour. A significant number of Mal ian contact lens wearers exhibited poor levels of hygiene and compliance with contact lenses and lens care systems. An effective educational reinforcement strategy needs to be developed to modify lens wearers' non-compliance.
Publisher: Wiley
Date: 24-10-2022
DOI: 10.1111/CEO.14177
Abstract: We aimed to determine the long‐term outcomes of epithelium‐off cross‐linking (CXL) in keratoconus patients. An observational registry study from 41 centres across 5 countries was carried out. Primary outcomes included the mean change in visual acuity (VA), Kmax, K2, and thinnest corneal thickness (TCT) at 1–5 years. Secondary outcomes included the percentage of eyes with worsening, stable and improving outcomes. There were 976 eyes of 794 patients with 1‐year of complete follow‐up, 501 eyes with 2‐years, 355 with 3‐years, 235 with 4‐years and 162 with 5‐years. There was a significant improvement in mean VA from baseline by 3.7 logMAR letters ( p 0.001) in year 1, and 6.9 ( p 0.001) in year 5. Mean Kmax decreased by 1.2 dioptres (D p 0.01) in year 1. During subsequent years the Kmax flattening appeared sustained but this was not statistically significant. K2 flattened significantly from baseline in year 1 and then remained stable. At 1 year, 4.1% patients were poor responders to CXL in terms of VA, losing ≥15 letters. The proportion of the poor responders remained unchanged: 4.9% at 5‐years. The proportion of poor responders in terms of Kmax remained similar: 5.9% steepening by ≥2D at 1‐year and 7.5% at 5‐years. The proportion of K2 poor responders remained stable with 4.7% steepening by ≥2D at 1‐year and 5.8% at 5‐years. Cross‐linking is effective at stabilising keratoconus up to 5 years in most patients. However, a small proportion of eyes failed to stabilise and had reduced vision.
Publisher: Informa UK Limited
Date: 10-01-2023
Publisher: Wiley
Date: 02-03-2021
DOI: 10.1111/OPO.12792
Abstract: To evaluate the psychometric properties of refractive error‐specific quality of life (QoL) item banks and assess their performance using computerised adaptive testing (CAT) simulations. In this cross‐sectional study a 392‐item questionnaire, grouped under 11 QoL domains, was interviewer‐administered to 305 people with refractive error [mean age ± S.D., 30.5 ± 14.1 (range (18 to 83) years male, 50.5% mean ± S.D. spherical equivalent refractive error −2.4 ± 2.9 (range: −15.0 to +11.0) Dioptres spectacles ( n = 257), contact lens ( n = 37), refractive surgery ( n = 25), uncorrected refractive error ( n = 57)]. Rasch analysis was conducted on each QoL domain using the Andrich rating scale model to investigate parameters including response category functioning, person‐ and item‐reliability, infit and outfit statistics, unidimensionality, targeting, differential item functioning and local item dependency. The resulting item banks underwent CAT simulations in 1,000 cases with 'high' and 'moderate' precision stopping rules. Rasch analysis iterations resulted in 13 refractive error‐specific item banks (Convenience, Health concerns, Economic, Activity limitation, Mobility, Emotional, Social, Visual symptoms frequency, Visual symptoms severity, Visual symptoms bothersome, Comfort symptoms frequency, Comfort symptoms severity and Comfort symptoms bothersome), containing a total of 366 items. The item banks had good psychometric properties including satisfactory measurement precision, infit and outfit statistics and unidimensionality. In CAT simulations, the mean number of items required to achieve high and moderate measurement precision was 9.4 and 4.7, respectively. Overall, refractive error‐specific QoL item banks show promise in their ability to comprehensively and precisely evaluate a range of quality of life parameters. These items banks when administered using a CAT system offer unique outcome tools for implementation in clinical trials, healthcare and research.
Publisher: Informa UK Limited
Date: 06-10-2018
DOI: 10.1080/09286586.2017.1376338
Abstract: The aim of this study was to explore the impact of corrected and uncorrected refractive error (URE) on Nepalese people's quality of life (QoL), and to compare the QoL status between refractive error subgroups. Participants were recruited from Tilganga Institute of Ophthalmology and Dhulikhel Hospital, Nepal. Semi-structured in-depth interviews were conducted with 101 people with refractive error. Thematic analysis was used with matrices produced to compare the occurrence of themes and categories across participants. Themes were identified using an inductive approach. Seven major themes emerged that determined refractive error-specific QoL: activity limitation, inconvenience, health concerns, psycho-social impact, economic impact, general and ocular comfort symptoms, and visual symptoms. Activity limitation, economic impact, and symptoms were the most important themes for the participants with URE, whereas inconvenience associated with wearing glasses was the most important issue in glasses wearers. Similarly, possibilities of having side effects or complications were the major concerns for participants wearing contact lens. In general, refractive surgery addressed socio-emotional impact of wearing glasses or contact lens. However, the surgery participants had concerns such as possibility of having to wear glasses again due to relapse of refractive error. Impact of refractive error on people's QoL is multifaceted. Significance of the identified themes varies by refractive error subgroups. Refractive correction may not always address QoL impact of URE but often add unique QoL issues. This study findings also provide content for developing an item-bank for quantitatively measuring refractive error-specific QoL in developing country setting.
Publisher: The Royal Society
Date: 03-11-2021
Publisher: Elsevier BV
Date: 06-2023
Publisher: Journal of Nepal Medical Association (JNMA)
Date: 28-02-2019
DOI: 10.31729/JNMA.3523
Abstract: Optometry is an independent profession which is specialised for providing comprehensive eye care including refraction and dispensing services, diagnosis and management of eye diseases and visual rehabilitation. In clinical settings of Nepal, optometrists are primarily recognised as refractionists and are provided with working opportunities in the same area. This report highlights other optomet- ric services such as binocular vision, multifocal lenses, contact lenses and occupational lens design which can be provided by optometrists besides performing refraction and prescribing spectacles. Considering large proportion of optometrists with further education and being working outside the country, new specialised services can be introduced through training and workshop to the fellow optometrists so that specialised services can reach up to the public level. Keywords: Nepal optometry refraction services.
Publisher: Elsevier BV
Date: 2022
Publisher: Informa UK Limited
Date: 16-06-2021
DOI: 10.1080/08164622.2021.1924626
Abstract: There is increasing focus on the value of real-world clinical registry data in multiple medical disciplines, including ophthalmology. However, disease-focused clinical registries that engage optometrists are rare. This paper introduces the Optometry Module of the Save Sight Keratoconus Registry (SSKR) and highlights the potential advantages it can offer to optometrists for improving their quality of patient care and for engaging in research. Optometrists are primary eye care providers and have a major role in providing clinical care to people with keratoconus. The SSKR system has been developed to collects high-quality information on essential clinical parameters including patient-reported outcomes (i.e., quality of life data). The real-world data from the Optometry Module of the SSKR can be analysed to obtain insights into contemporary optometry keratoconus practice, and be used to identify opportunities for improving clinical care. Optometrists' engagement with the registry supports reflective clinical practice through real-time benchmarking. Optometrists can use the registry system to track patient outcomes, and it provides a framework for educating patients about their keratoconus journey. The system also captures details relating to patient adverse events, with subsequent data analysis enabling risk factors for such events to be identified. In summary, the Optometry Module of the SSKR captures real-world clinical evidence that has the potential to inform practice improvement, facilitate safety surveillance and enable outcomes research in keratoconus, all with the ultimate intent of enhancing care for people living with keratoconus.
Publisher: Elsevier BV
Date: 08-2022
Publisher: Wiley
Date: 15-05-2017
DOI: 10.1111/CEO.12954
Abstract: This study qualitatively explores the impact of refractive error on adults, particularly after correction. The study aimed to explore the impact of refractive error on quality of life. Cross-sectional in-depth telephone and face-to-face semistructured interviews qualitative study with inductive and deductive processes. Forty-eight adults with refractive error (including presbyopia) were recruited from the Flinders Vision, the Ashford Advanced Eye Care and among Flinders University staff and students, in South Australia. The interviews were audio-recorded, transcribed verbatim, coded and analysed using thematic analysis. Themes and categories RESULTS: The median age of the participants was 49 years (min: 22 years max: 76 years). Most of them were female: (29 59%). Most of them (36 75.0%) had myopia followed by hyperopia (12 25.0%). Twenty-two (45.8%) participants had astigmatism. Similarly, 23 (47.9%) of them were presbyopes. Most of the participants (39 81.3%) wore glasses 17 (35.4%) used contact lenses, and 17 (35.4%) had undergone refractive surgery. A total of 2367 comments were coded. Thematic analysis resulted into six themes that informed about quality of life issues in people with refractive error. Concerns about cosmetic appearance, personal health and safety, difficulties in day-to-day activities and inconveniences rendered in daily life were identified as the most important themes. The findings of this study enrich the understanding on the issues important in people with refractive error. The quality of life issues identified will be used to develop a refractive error-specific item bank.
Publisher: Wiley
Date: 09-03-2021
DOI: 10.1111/OPO.12796
Abstract: Spectacle non‐tolerance or adverse events to spectacle wear are serious concerns for both patients and practitioners. Non‐tolerance may contribute to a negative impact on the practitioner’s ability and practice. Therefore, a detailed understanding of frequency and causes of spectacle non‐tolerance in clinical ophthalmic practice is essential. This review aimed to determine the prevalence and causes of non‐tolerance to spectacles prescribed and dispensed in clinical practice. The current systematic review included quantitative studies published in the English language that reported spectacle non‐tolerance in clinical practice. A comprehensive search was conducted in PubMed, Scopus and the Web of Science database for studies published until 13 July 2020. An adapted version of the Newcastle‐Ottawa Scale (NOS) modified for cross‐sectional studies was used to assess the quality of each included study. Five investigations with 205,478 study participants were included in the review. The prevalence of spectacle non‐tolerance from in idual studies was pooled using MetaXL software. The pooled prevalence of spectacle non‐tolerance was 2.1% (95% CI: 1.6–2.7) ranging from 1.6% to 3.0%. The papers were also reviewed to identify the potential causes of non‐tolerances. Nearly half reported that non‐tolerance (47.4%) was due to an error in refraction. Other causes identified were errors related to communication (16.3%), dispensing (13.5%), non‐adaptation (9.7%), data entry (8.7%), binocular vision (7.4%) and ocular pathology (6.4%). This review improves our understanding of spectacle non‐tolerance in clinical practice. This is important because non‐tolerance may lead to spectacle wear discontinuation, which may deprive patients of optimal vision. Increased non‐tolerance in clinical practice may affect a clinician’s reputation and incur additional costs associated with reassessments and replacements. Spectacle non‐tolerance occurred due to a multitude of factors related to optical dispensing and wearer adaptation. Therefore, there is a need for vigilance while prescribing spectacles. The limited evidence highlights the need for more studies, especially in limited‐resource settings, to improve the quality of refractive error services.
Publisher: Elsevier BV
Date: 02-2021
Publisher: SLACK, Inc.
Date: 06-2017
DOI: 10.3928/1081597X-20170310-01
Abstract: To identify the questionnaires used to assess refractive surgery outcomes, assess the available questionnaires in regard to their psychometric properties, validity, and reliability, and evaluate the performance of the available questionnaires in measuring refractive surgery outcomes. An extensive literature search was done on PubMed, MEDLINE, Scopus, CINAHL, Cochrane, and Web of Science databases to identify articles that described or used at least one questionnaire to assess refractive surgery outcomes. The information on content quality, validity, reliability, responsiveness, and psychometric properties was extracted and analyzed based on an extensive set of quality criteria. Eighty-one articles describing 27 questionnaires (12 refractive error–specific, including 4 refractive surgery–specific, 7 vision-but-non-refractive, and 8 generic) were included in the review. Most articles (56, 69.1%) described refractive error–specific questionnaires. The Quality of Life Impact of Refractive Correction (QIRC), the Quality of Vision (QoV), and the Near Activity Visual Questionnaire (NAVQ) were originally constructed using Rasch analysis others were developed using the Classical Test Theory. The National Eye Institute Refractive Quality of Life questionnaire was the most frequently used questionnaire, but it does not provide a valid measurement. The QoV, QIRC, and NAVQ are the three best existing questionnaires to assess visual symptoms, quality of life, and activity limitations, respectively. This review identified three superior quality questionnaires for measuring different aspects of quality of life in refractive surgery. Clinicians and researchers should choose a questionnaire based on the concept being measured with superior psychometric properties. [ J Refract Surg. 2017 (6):416–424.]
Publisher: Elsevier BV
Date: 10-2021
Publisher: Wiley
Date: 11-07-2023
DOI: 10.1111/ALL.15807
Abstract: Asthma and atopic dermatitis (AD) are chronic allergic conditions, along with allergic rhinitis and food allergy and cause high morbidity and mortality both in children and adults. This study aims to evaluate the global, regional, national, and temporal trends of the burden of asthma and AD from 1990 to 2019 and analyze their associations with geographic, demographic, social, and clinical factors. Using data from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2019, we assessed the age‐standardized prevalence, incidence, mortality, and disability‐adjusted life years (DALYs) of both asthma and AD from 1990 to 2019, stratified by geographic region, age, sex, and socio‐demographic index (SDI). DALYs were calculated as the sum of years lived with disability and years of life lost to premature mortality. Additionally, the disease burden of asthma attributable to high body mass index, occupational asthmagens, and smoking was described. In 2019, there were a total of 262 million [95% uncertainty interval (UI): 224–309 million] cases of asthma and 171 million [95% UI: 165–178 million] total cases of AD globally age‐standardized prevalence rates were 3416 [95% UI: 2899–4066] and 2277 [95% UI: 2192–2369] per 100,000 population for asthma and AD, respectively, a 24.1% [95% UI: −27.2 to −20.8] decrease for asthma and a 4.3% [95% UI: 3.8–4.8] decrease for AD compared to baseline in 1990. Both asthma and AD had similar trends according to age, with age‐specific prevalence rates peaking at age 5–9 years and rising again in adulthood. The prevalence and incidence of asthma and AD were both higher for in iduals with higher SDI however, mortality and DALYs rates of in iduals with asthma had a reverse trend, with higher mortality and DALYs rates in those in the lower SDI quintiles. Of the three risk factors, high body mass index contributed to the highest DALYs and deaths due to asthma, accounting for a total of 3.65 million [95% UI: 2.14–5.60 million] asthma DALYs and 75,377 [95% UI: 40,615–122,841] asthma deaths. Asthma and AD continue to cause significant morbidity worldwide, having increased in total prevalence and incidence cases worldwide, but having decreased in age‐standardized prevalence rates from 1990 to 2019. Although both are more frequent at younger ages and more prevalent in high‐SDI countries, each condition has distinct temporal and regional characteristics. Understanding the temporospatial trends in the disease burden of asthma and AD could guide future policies and interventions to better manage these diseases worldwide and achieve equity in prevention, diagnosis, and treatment.
Publisher: Elsevier BV
Date: 07-2022
Publisher: Elsevier BV
Date: 08-2021
Publisher: Wiley
Date: 11-02-2022
DOI: 10.1111/OPO.12956
Abstract: To compare corneal topography, pachymetry and higher order aberrations in keratoconic and normal eyes to investigate their association in keratoconic eyes and to determine their diagnostic ability for detecting subclinical keratoconus in a Nepalese population. Ninety-six eyes of 48 keratoconus patients and 50 normal eyes of 50 control subjects were included in this study. The eyes of keratoconus patients were classified into four different study groups: subclinical, stage 1, stage 2 and advanced stage keratoconus. In each eye, corneal topography, pachymetry and corneal aberrometry indices were measured using a Sirius corneal tomographer. The study parameters of keratoconic eyes were compared with normal eyes, and the possible association of corneal aberrometry with topography and pachymetry indices was investigated. The area under curve (AUC) of receiver operating characteristic (ROC) curves along with optimal cutoff values with best sensitivity and specificity were also determined for each index to detect subclinical keratoconus. All the indices except average keratometry measurements (K Corneal higher order aberrations were found to be significantly elevated in subclinical keratoconus compared to healthy controls. SI
Location: United States of America
Location: United Kingdom of Great Britain and Northern Ireland
Location: Eritrea
Location: Kenya
Location: Eritrea
No related grants have been discovered for Himal Kandel.