Agreement in dry eye management between optometrists and general practitioners in primary health care in the Netherlands

The final publication is available at Elsevier via http://dx.doi.org/10.1016/j.clae.2015.03.005 © 2015. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Purpose: To investigate the agreement in dry eye care management between general practitioners (GPs) and optometrists in the Netherlands. Methods: A web-based survey was used to investigate the agreement in symptoms associated with dry eye, causes of developing dry eye, and investigative techniques used in practice, between GPs and optometrists. Additional questions surveyed knowledge of the latest research, and co-management of dry eye disease in primary healthcare. The anonymised questionnaire contained 16 forced-choice questions with Likert scales, and was sent to 1471 general medical practitioners and 870 registered optometrists. The response data was stored on an online database, and was converted directly to text format for analysis using SPSS 21 statistical analysis software. Results: 138 optometrists and 93 GPs responded to the survey (Cronbach α = 0.885, optometrists, and 0.833, GPs). Almost no agreement was found for all the questions: a statistically significant difference (Chi-square p 0.0001), and dry eye symptoms, except for ‘burning sensation of the eye’ and ‘irritation of the eye’ as agreed symptoms, and agreement that dry eye is an age-related disease. Conclusions: As the optometrist and the GP are the gatekeepers for secondary healthcare, the fundamental differences in the methods of investigation and interpretation of dry eye-related symptoms, the possible cause of developing dry eye disease, and the therapy given by GPs and optometrists in the Netherlands, may have a significant impact on consistency of patient care.The authors extend their appreciation to the University of Applied Sciences Utrecht for funding this researc

Assessment of the repeatability in an automatic methodology for hyperemia grading in the bulbar conjunctiva

When the vessels of the bulbar conjunctiva get congested with blood, a characteristic red hue appears in the area. This symptom is known as hyperemia, and can be an early indicator of certain pathologies. Therefore, a prompt diagnosis is desirable in order to minimize both medical and economic repercussions. A fully automatic methodology for hyperemia grading in the bulbar conjunctiva was developed, by means of image processing and machine learning techniques. As there is a wide range of illumination, contrast, and focus issues in the images that specialists use to perform the grading, a repeatability analysis is necessary. Thus, the validation of each step of the methodology was performed, analyzing how variations in the images are translated to the results, and comparing them to the optometrist's measurements. Our results prove the robustness of our methodology to various conditions. Moreover, the differences in the automatic outputs are similar to the optometrist's ones

Cystic Fibrosis and the eye

Cystic Fibrosis (CF) results from the defective function of CF Transmembrane Conductance Regulator (CFTR), an ion channel which facilitates epithelial chloride secretion. Previous observations of dry eye and abnormal visual function in CF subjects have been considered secondary manifestations due to associated vitamin A deficiency (VAD) and CF-related diabetes (CFRD). However, CFTR is fundamentally present in the corneal, conjunctival and retinal pigment epithelium and the corneal endothelium. The hypothesis for this thesis was that abnormal chloride secretion in CF causes reduced basal tear secretion and abnormal photoreceptor function: these investigations aimed to identify primary and secondary ocular manifestations of CF. Fluorescein tear break-up time was significantly reduced in adult CF subjects compared to healthy controls. Increased signs of ocular surface inflammation and higher tear feming grades were recorded in CF subjects, although differences failed to reach significance. Tear film stability was further reduced in CF adults with VAD suggesting the aetiology of dry eye appears to be a combination of primary and secondary manifestations of the disease. Visual function was essentially normal in CF juveniles but was adversely affected in CF adults compared to controls. Impaired distance and near visual acuity (DVA and NVA), contrast sensitivity (CS), dark adaptation (DA) and colour vision (CV) appeared to be a primary manifestation as differences were exaggerated in subjects with predicted increased levels of CFTR disruption and disease severity. These results provide support for the hypothesis and suggest normal rod and cone photoreceptor function are compromised by abnormal CFTR action. DVA, NVA, CS and DA were significantly affected by CFRD status and DA and CV were similarly reduced in VAD subjects. Therefore, abnormal visual function in CF is further modulated by secondary disease characteristics. These findings present the distinction between primary and secondary ocular manifestations of CF, which is novel to this investigation

Defining the Optimal Region of Interest for Hyperemia Grading in the Bulbar Conjunctiva

Conjunctival hyperemia or conjunctival redness is a symptom that can be associated with a broad group of ocular diseases. Its levels of severity are represented by standard photographic charts that are visually compared with the patient’s eye. This way, the hyperemia diagnosis becomes a nonrepeatable task that depends on the experience of the grader. To solve this problem, we have proposed a computer-aided methodology that comprises three main stages: the segmentation of the conjunctiva, the extraction of features in this region based on colour and the presence of blood vessels, and, finally, the transformation of these features into grading scale values by means of regression techniques. However, the conjunctival segmentation can be slightly inaccurate mainly due to illumination issues. In this work, we analyse the relevance of different features with respect to their location within the conjunctiva in order to delimit a reliable region of interest for the grading. The results show that the automatic procedure behaves like an expert using only a limited region of interest within the conjunctivaThis research has been partially supported by the Ministerio de Economía y Competitividad through the Research Contract DPI2015-69948-R. María Luisa Sánchez Brea acknowledges the support of the University of A Coruna though the Inditex-UDC Grant ProgramS

Impairment of neutrophil oxidative burst in children with sickle cell disease is associated with heme oxygenase-1.

Sickle cell disease is a risk factor for invasive bacterial infections, and splenic dysfunction is believed to be the main underlying cause. We have previously shown that the liberation of heme in acute hemolysis can induce heme oxygenase-1 during granulopoiesis, impairing the ability of developing neutrophils to mount a bactericidal oxidative burst, and increasing susceptibility to bacterial infection. We hypothesized that this may also occur with the chronic hemolysis of sickle cell disease, potentially contributing to susceptibility to infections. We found that neutrophil oxidative burst activity was significantly lower in treatment-naïve children with sickle cell disease compared to age-, gender- and ethnicity-matched controls, whilst degranulation was similar. The defect in neutrophil oxidative burst was quantitatively related to both systemic heme oxygenase-1 activity (assessed by carboxyhemoglobin concentration) and neutrophil mobilization. A distinct population of heme oxygenase-1-expressing cells was present in the bone marrow of children with sickle cell disease, but not in healthy children, with a surface marker profile consistent with neutrophil progenitors (CD49d(Hi) CD24(Lo) CD15(Int) CD16(Int) CD11b(+/-)). Incubation of promyelocytic HL-60 cells with the heme oxygenase-1 substrate and inducer, hemin, demonstrated that heme oxygenase-1 induction during neutrophilic differentiation could reduce oxidative burst capacity. These findings indicate that impairment of neutrophil oxidative burst activity in sickle cell disease is associated with hemolysis and heme oxygenase-1 expression. Neutrophil dysfunction might contribute to risk of infection in sickle cell disease, and measurement of neutrophil oxidative burst might be used to identify patients at greatest risk of infection, who might benefit from enhanced prophylaxis

Understanding the outcome of police safeguarding notifications to social services in South Wales

In the UK, demand for the police has changed, with the majority of calls now vulnerability-related. Police safeguarding notifications (N=3,466) over a one-year period for a local authority in Wales were matched to social care records. Over half (57.5%) of notifications were referred to social services and only 4.8% received social service input (e.g. social worker intervention). Over a third of individuals had repeat notifications in the study year. Findings evidence high levels of police-identified vulnerability and an imbalance in vulnerability-related risk thresholds across agencies. Furthermore, some individuals require more appropriate action to mitigate the risk of future safeguarding notifications