Pre-operative experiences and post-operative benefits of ptosis surgery: A qualitative study

© 2017 Taylor & Francis. This qualitative study sought to explore the experiences of patients who had undergone successful ptosis correction surgery. Participants were recruited from Bristol Eye Hospital. Nine participants were interviewed using a semi-structured interview schedule and open ended questions. Data were analysed using inductive thematic analysis. Four major themes were identified from patient accounts. Patients described the psychosocial and functional difficulties they experienced living with ptosis, and the subsequent benefits of surgery. Patients reported experiencing appearance related anxiety pre-operatively due to their condition and engaging in behaviours to avoid social encounters. Gender differences were noted in the internalization of perceived negative reactions from others, with men describing fewer adverse impacts. Patients described perceived barriers to seeking surgery including a lack of awareness of ptosis as a treatable condition, the perception that being concerned with their appearance could be seen as vain and the view that ptosis surgery is synonymous with cosmetic surgery. Following successful surgery patients outlined positive impacts on their vision, appearance and psychosocial well-being after successful surgery. This qualitative study highlights the complexities of the factors and processes contributing to the psychosocial impacts of ptosis and the potential benefits of surgery and/or psychosocial support. An increased awareness amongst people with ptosis of the potential positive impacts of surgery and an enhanced understanding of the reasons why patients may not seek treatment amongst health care professionals are likely to benefit this often overlooked patient group

Cluster randomised trial of a tailored intervention to improve the management of overweight and obesity in primary care in England

Background: Tailoring is a frequent component of approaches for implementing clinical practice guidelines, although evidence on how to maximise the effectiveness of tailoring is limited. In England, overweight and obesity are common, and national guidelines have been produced by the National Institute for Health and Care Excellence. However, the guidelines are not routinely followed in primary care. Methods: A tailored implementation intervention was developed following an analysis of the determinants of practice influencing the implementation of the guidelines on obesity and the selection of strategies to address the determinants. General practices in the East Midlands of England were invited to take part in a cluster randomised controlled trial of the intervention. The primary outcome measure was the proportion of overweight or obese patients offered a weight loss intervention. Secondary outcomes were the proportions of patients with (1) a BMI or waist circumference recorded, (2) record of lifestyle assessment, (3) referred to weight loss services, and (4) any change in weight during the study period. We also assessed the mean weight change over the study period. Follow-up was for 9 months after the intervention. A process evaluation was undertaken, involving interviews of samples of participating health professionals. Results: There were 16 general practices in the control group, and 12 in the intervention group. At follow-up, 15. 08 % in the control group and 13.19 % in the intervention group had been offered a weight loss intervention, odds ratio (OR) 1.16, 95 % confidence interval (CI) (0.72, 1.89). BMI/waist circumference measurement 42.71 % control, 39.56 % intervention, OR 1.15 (CI 0.89, 1.48), referral to weight loss services 5.10 % control, 3.67 % intervention, OR 1.45 (CI 0.81, 2.63), weight management in the practice 9.59 % control, 8.73 % intervention, OR 1.09 (CI 0.55, 2.15), lifestyle assessment 23.05 % control, 23.86 % intervention, OR 0.98 (CI 0.76, 1.26), weight loss of at least 1 kg 42.22 % control, 41.65 % intervention, OR 0.98 (CI 0.87, 1.09). Health professionals reported the interventions as increasing their confidence in managing obesity and providing them with practical resources. Conclusions: The tailored intervention did not improve the implementation of the guidelines on obesity, despite systematic approaches to the identification of the determinants of practice. The methods of tailoring require further development to ensure that interventions target those determinants that most influence implementation

Incidence, risk factors and management of intractable diplopia

AimsThere is a paucity of literature concerning intractable diplopia. The aims of this study were to determine the incidence of intractable diplopia in the UK, identify the causes and any associated risk factors, establish how cases are managed and if the treatment is successful and tolerated.MethodsA 1-year prospective observational study was undertaken via the British Ophthalmological Surveillance Unit (BOSU). This involved implementation of a reporting mechanism, which then triggered distribution of an incident questionnaire to explore clinical details concerning each case and a follow-up questionnaire 6 months later to explore how the case had been managed.ResultsThe incidence of intractable diplopia was 53 cases per year. The most common preceding events were strabismus surgery (32%), no known preceding event, that is,spontaneous (25%), severe head trauma (8%), cataract surgery (6%) and vitrectomy (6%). In the at-risk age group of 7 years and above, the incidence of intractable diplopia following strabismus surgery is 1 in 494 (95% CI; 1 in 296 to 790) cases. A total of nine different treatments were used in the management, with many patients receiving between two and four different methods. The overall success rate was poor, but most effective were opaque intraocular lenses (IOLs) (86%) and opaque contact lenses (50%).ConclusionIntractable diplopia is a relatively rare but important condition. The main risk factor is a pre-existing strabismus, and careful counselling is needed when planning surgical correction in patients with no demonstrable binocular function. Treatment success of intractable diplopia is high when using opaque IOLs, although with additional risk, but is often disappointing via other methods where it can be difficult to eradicate the diplopia successfully.</jats:sec

The psychosocial impact of ptosis as a symptom of myasthenia gravis: A qualitative study

The aim of this qualitative study was to investigate the psychosocial impact of ptosis as a symptom of Myasthenia Gravis (MG). Participants were recruited from a MG patient group on Facebook. 166 participants answered a series of open ended questions examining the impact of ptosis, and responses were analysed using Inductive Thematic Analysis, which revealed four main themes. The first highlighted the extent to which ptosis impacted negatively on psychosocial functioning. The second related to ways in which ptosis can be framed in a positive way, eg, as a believable symptom. The final two themes revealed the complex inter-relationships between functional and appearance-related impacts, and a desire from many participants for health care professionals to provide more support directly related to their ptosis. This study suggests that ptosis impacts in ways not currently recognized in literature and practice. © 2014 Informa Healthcare USA, Inc. All rights reserved

Levator function revisited: a two-phase assessment of lid movement to better identify levator-superior rectus synkinesis.

AIM: To assess a two-phase method of recording levator function in order to facilitate the identification of patients with ptosis who have a synkinesis between the levator and superior rectus muscles. METHODS: 40 consecutive patients who attended oculoplastic clinics with ptosis and 22 patients with normal lid function were recruited. In each subject, levator function was recorded by the conventional method, measuring total upper eyelid excursion between the extremes of down-gaze and up-gaze. Levator function was also assessed using our novel two-phase approach in which upper-eyelid excursion is measured separately between down-gaze and primary position (Phase 1), and between primary position and up-gaze (Phase 2). RESULTS: In normal patients and most of the patients with ptosis, the majority of lid movement and hence levator function occurs between down-gaze and the primary position (Phase1). In those patients with ptosis and levator-superior rectus synkinesis, a higher proportion of lid movement occurred on up-gaze (Phase2). CONCLUSION: The two-phase measurement of lid movement highlights levator function in differing gaze positions and facilitates the identification of those patients with levator-superior rectus synkinesis

Why can't my child see 3D television?

A child encountering difficulty in watching three-dimensional (3D) stereoscopic displays could have an underlying ocular disorder. It is therefore valuable to understand the differential diagnoses and so conduct an appropriate clinical assessment to address concerns about poor 3D vision. </jats:p

Interocular Asymmetries in Axial Length and Refractive Error in 4 Cohorts

2014-2015 > Academic research: refereed > Publication in refereed journa

Polybrominated diphenyl ether serum concentrations in a Californian population of children, their parents, and older adults: an exposure assessment study

BackgroundPolybrominated diphenyl ethers (PBDEs) are used as flame retardants in many household items. Given concerns over their potential adverse health effects, we identified predictors and evaluated temporal changes of PBDE serum concentrations.MethodsPBDE serum concentrations were measured in young children (2-8 years old; N = 67), parents of young children (&lt;55 years old; N = 90), and older adults (≥55 years old; N = 59) in California, with concurrent floor wipe samples collected in participants' homes in 2008-2009. We also measured serum concentrations one year later in a subset of children (N = 19) and parents (N = 42).ResultsPBDE serum concentrations in children were significantly higher than in adults. Floor wipe concentration is a significant predictor of serum BDE-47, 99, 100 and 154. Positive associations were observed between the intake frequency of canned meat and serum concentrations of BDE-47, 99 and 154, between canned meat entrees and BDE-154 and 209, as well as between tuna and white fish and BDE-153. The model with the floor wipe concentration and food intake frequencies explained up to 40% of the mean square prediction error of some congeners. Lower home values and renting (vs. owning) a home were associated with higher serum concentrations of BDE-47, 99 and 100. Serum concentrations measured one year apart were strongly correlated as expected (r = 0.70-0.97) with a slight decreasing trend.ConclusionsFloor wipe concentration, food intake frequency, and housing characteristics can explain 12-40% of the prediction error of PBDE serum concentrations. Decreasing temporal trends should be considered when characterizing long-term exposure