Trends in provision of photodynamic therapy and clinician attitudes: a tracker survey of a new health technology

BACKGROUND: There has been debate about the cost-effectiveness of photodynamic therapy (PDT), a treatment for neovascular age-related macular degeneration. We have been monitoring trends for the provision of PDT in the UK National Health Service. The fourth annual 'tracker' survey took place as definitive National Institute for Clinical Excellence (NICE) guidance was issued. We assessed trends in PDT provision up to the point of release of the NICE guidance and identified likely sources of pressure on ophthalmologists to provide PDT. METHODS: National postal questionnaire survey of clinicians with potential responsibility for PDT provision. The survey explored reported local provision, beliefs about the effectiveness of PDT and what sources of opinion might influence attitudes towards providing PDT. RESULTS: The response rate was 73% (111/150). Almost half of the surveyed ophthalmology units routinely provided PDT, as part of a trend of steady growth in provision. The proportion of respondents who believed that further proof of effectiveness was required has also declined despite the absence of any new substantial evidence. Attitudes towards providing PDT were positive, on average, and were more strongly associated with perceived social pressure from local colleagues than from other sources. Local colleagues were seen as being most approving of PDT. CONCLUSION: Those responsible for implementing the NICE guidance need to address ophthalmologists' beliefs about the evidence of effectiveness for PDT and draw upon supportive local individuals or networks to enhance the credibility of the guidance

The incidence of idiopathic intracranial hypertension in Scotland : a SOSU study

This study was supported by the Scottish Ophthalmic Surveillance Unit, through the Ross Foundation SOSU study bursary.Background: Idiopathic intracranial hypertension most commonly affects women of childbearing age and usually causes headache and intermittent visual obscurations. Some patients suffer permanent visual loss. The major modifiable risk factor associated with IIH is obesity. Scotland has one of the poorest records for obesity in the western world, with a prevalence in 2016 of 29% in the adult population. We aimed to establish the incidence of idiopathic intracranial hypertension (IIH) in Scotland. Methods: All new cases of IIH seen in Scotland were collected over a 1-year period. Cases were reported by ophthalmologists through the Scottish Ophthalmic Surveillance Unit (SOSU) and by neurologists directly to the investigators using encrypted NHS emails. An open dialogue was maintained between the investigators and specialist neuro-ophthalmology clinics throughout the year to minimise the risk of under-reporting. Cases were defined using the Modified Dandy Diagnostic Criteria. Results: One hundred and forty-four confirmed cases of IIH were reported. One hundred and ten out of 144 patients were female and aged 15–44. The mean BMI in this group was 38.9. Conclusions: The incidence of IIH in Scotland is at least 2.65/100,000. This figure rises to 37.9/100,000 in obese females aged 15–44. This figure is higher than previously published and is probably a result of increasing levels of obesity across the nation. The significant morbidity caused by IIH, in this young population raises the question of whether enough is being done to prevent and treat Scotland’s obesity crisis.PostprintPeer reviewe

Identifying priority review questions for Cochrane Eyes and Vision: protocol for a priority setting exercise

INTRODUCTION: Cochrane Eyes and Vision (CEV) is an international network of individuals working to prepare, maintain and promote access to systematic reviews of interventions to treat, prevent or diagnose eye diseases or vision impairment. CEV plans to undertake a priority setting exercise to identify systematically research questions relevant to our scope, and to formally incorporate input from a wide range of stakeholders to set priorities for new and updated reviews. METHODS AND ANALYSIS: The scope of CEV is broad and our reviews include conditions that are common and have a high global disease burden, for example, cataract and dry eye disease, and conditions that are rare but have a high impact on quality of life and high individual cost such as eye cancer. We plan to focus on conditions prioritised by WHO during the development of the Package of Eye Care Interventions. These conditions were selected based on a combination of data on disease magnitude, healthcare use and expert opinion. We will identify priority review questions systematically by summarising relevant data on research in Eyes and Vision from a range of sources, and compiling a list of 10-15 potential review questions (new and/or updates) for each condition group. We will seek the views of external and internal stakeholders on this list by conducting an online survey. Equity will be a specific consideration. ETHICS AND DISSEMINATION: The study has been approved by the ethics committee of the London School of Hygiene & Tropical Medicine. We will disseminate the findings through Cochrane channels and prepare a summary of the work for publication in a peer-reviewed journal

The incidence of idiopathic intracranial hypertension in Scotland:a SOSU study

Background: Idiopathic intracranial hypertension most commonly affects women of childbearing age and usually causes headache and intermittent visual obscurations. Some patients suffer permanent visual loss. The major modifiable risk factor associated with IIH is obesity. Scotland has one of the poorest records for obesity in the western world, with a prevalence in 2016 of 29% in the adult population. We aimed to establish the incidence of idiopathic intracranial hypertension (IIH) in Scotland.Methods: All new cases of IIH seen in Scotland were collected over a 1-year period. Cases were reported by ophthalmologists through the Scottish Ophthalmic Surveillance Unit (SOSU) and by neurologists directly to the investigators using encrypted NHS emails. An open dialogue was maintained between the investigators and specialist neuro-ophthalmology clinics throughout the year to minimise the risk of under-reporting. Cases were defined using the Modified Dandy Diagnostic Criteria.Results: One hundred and forty-four confirmed cases of IIH were reported. One hundred and ten out of 144 patients were female and aged 15–44. The mean BMI in this group was 38.9.Conclusions: The incidence of IIH in Scotland is at least 2.65/100,000. This figure rises to 37.9/100,000 in obese females aged 15–44. This figure is higher than previously published and is probably a result of increasing levels of obesity across the nation. The significant morbidity caused by IIH, in this young population raises the question of whether enough is being done to prevent and treat Scotland’s obesity crisis.</p

Childhood uveitis not associated with juvenile idiopathic arthritis:a national survey of incidence, management and visual outcomes

AIMS: To estimate the incidence of childhood uveitis not associated with juvenile idiopathic arthritis (JIA) in the United Kingdom. METHODS: Children under 16 years who presented with a new diagnosis of uveitis from November 2014 to October 2015 were identified prospectively through the British and Scottish Ophthalmological Surveillance Unit reporting card system. Incident questionnaires were sent to reporting ophthalmologists at presentation and 12 months. RESULTS: From 1st November 2014 to 31st October 2015, 119 cases were reported. Thirty-nine cases were excluded. The estimated minimum annual incidence of non-JIA uveitis in children younger than 16 years is 0.66 per 100,000 (95% CI 0.52–0.82). Median age at presentation was 10 years. 73% had bilateral uveitis. Median (IQR) BCVA in the worse eye was 0.3 (IQR 0.1–0.66) logMAR. The location of uveitis was: anterior 36%, intermediate 24%, posterior 6.8% and panuveitis 30%. 70% of cases were idiopathic. Most children were started on topical corticosteroids at presentation (86%, n = 51). At presentation, 31% (n = 19) were on started on systemic corticosteroids. At 1 year only 13% (n = 7) remained on corticosteroids, with the majority transitioned to steroid-sparing agents: methotrexate (30.8%, n = 16), mycophenolate (5.8%) and anti-TNF agents 5 (9.6%). At 1 year, 46% had ongoing intraocular inflammation despite treatment. The most common ocular adverse event was raised intraocular pressure (13.5%, n = 7). CONCLUSION: Our study provides the first national population-based data of non-JIA childhood uveitis. Most children remain on treatment at 1 year, but visual acuity improves and none were eligible for sight-impairment registration

The incidence of acute angle closure in Scotland:a prospective surveillance study

Purpose To estimate the incidence, and describe the clinical features and short-term clinical outcomes of acute angle closure (AAC). Methods Patients with newly diagnosed AAC were identified prospectively over a 12-month period (November 2011 to October 2012) by active surveillance through the Scottish Ophthalmic Surveillance Unit reporting system. Data were collected at case identification and at 6 months follow-up. Results There were 114 cases (108 patients) reported, giving an annual incidence of 2.2 cases (95% CI 1.8 to 2.6) or 2 patients (95% CI 1.7 to 2.4) per 1 00 000 in the whole population in Scotland. Precipitating factors were identified in 40% of cases. Almost one in five cases was associated with topical dilating drops. Best-corrected visual acuity (BCVA) at presentation ranged from 6/6 to perception of light. The mean presenting intraocular pressure (IOP) was 52 mm Hg (SD 11). Almost 30% cases had a delayed presentation of 3 or more days. At 6 months follow-up, 75% had BCVA of 6/12 or better and 30% were found to have glaucoma at follow-up. Delayed presentation (≥3 days) was associated with higher rate of glaucoma at follow-up (22.6% vs 60.8%, p&lt;0.001), worse VA (0.34 vs 0.74 LogMAR, p&lt;0.0001) and need for more topical medication (0.52 vs 1.2, p=0.003) to control IOP. Conclusion The incidence of AAC in Scotland is relatively low compared with the Far East countries, but in line with previous European data. Almost one in five cases were associated with pupil dilation for retinal examination.</p