Efficacy of Coloured Overlays and Lenses for the Treatment of Reading Difficulty: An Overview of Systematic Reviews

Background Coloured overlays or lenses are widely available for use by children and adults with difficulties or discomfort while reading. In recent years, systematic reviews have been conducted in an attempt to establish the strength of the evidence base for this intervention. The aims of this overview is to systematically review these reviews. Method The methodology was published prospectively as a protocol (Prospero CRD42017059172). Online databases Medline, Cinahl, Ovid and the Cochrane library were searched for systematic reviews on the efficacy of coloured overlays or lenses for the alleviation of reading difficulty or discomfort. Included studies were appraised using the AMSTAR 2 checklist. Characteristics of included studies including aspects of methods, results and conclusions were recorded. Both processes were conducted independently by two reviewers and any discrepancies were resolved by discussion. Results Thirty-one studies were found via databases and other sources. After excluding duplicates and those not fitting the inclusion criteria, four reviews were included in the analysis. While all reviews were systematic, their methodology, results and conclusions differed. Three of the four concluded that there is insufficient good quality evidence to support the use of coloured overlays or lenses for reading difficulty, while one concluded that, despite research limitations, the evidence does support their use. Conclusions On balance, systematic reviews to date indicate that there is not yet a reliable evidence base on which to recommend coloured overlays or lenses for the alleviation of reading difficulty or discomfort. High quality, low bias research is needed to investigate their effectiveness in different forms of reading difficulty and discomfort for adults and children

Sydenham's chorea - clinical and therapeutic update 320 years down the line

No Abstract. South African Medical Journal Vol. 96(9) (Part 2) 2006: 906-91

Seeing new opportunities to help smokers quit: A UK national survey of optometrist delivered smoking cessation behavioural support interventions

Background: Smoking is a risk factor for various eye conditions. Brief smoking cessation interventions have demonstrated effectiveness when delivered by a range of healthcare professionals. Optometrists are well-placed in the community to advise otherwise healthy smokers to quit, yet remain relatively neglected in smoking cessation research and policy. In a national survey, this study investigated self-reported practices of UK optometrists for delivering brief tobacco smoking cessation interventions to patients. Methods: A randomly selected sample of 1,200 optometrists out of the 9000 optometrists registered on the UK College of Optometrists database were invited to complete a 40-item, web-based survey assessing: training related to smoking cessation; current practice [i.e. the proportion of patients to which components of very brief advice (Ask, Advise, Assist) and other evidence-based smoking cessation behaviour change techniques were delivered]; and barriers/enablers to intervention delivery. Results: In total, 408 (34%) responses were received. Most (83%) optometrists received no training in practical skills for delivering smoking cessation support. A third (34%) routinely assessed smoking status. Fewer self-reported advising smokers to quit (22%), offering assistance (via referral to dedicated services) (3%), or advice on smoking cessation medications (2%). Perceived barriers included insufficient knowledge/training (81%) and time (65%). Optometrists were more likely to assess and advise on smoking cessation if they practised in Scotland (χ²(2)=32.95,  p<0.001), an independent optometry practice (χ²(1)=4.27,  p=0.39), or had received smoking cessation training χ²(1)=13.1,  p<0.001). Conclusions: Substantial gaps exist in UK optometrists' current smoking cessation training and practice. Evidence-based training resources are needed to support the implementation of smoking cessation interventions into routine optometry practice. Implications: Optometrists are well placed in the community to delivery brief advice interventions to a large population of smokers. This survey provides a comprehensive description of current UK optometry practice related to the provision of evidence-based brief tobacco smoking cessation interventions to patients. Although optometrists perceive advising on smoking cessation as part of their role, numerous substantial gaps in current practice and training remain which need to be addressed through targeted interventions to increase implementation

Is cardiac surgery warranted in children with Down syndrome? A case-controlled review

Objectives. To compare children with Down syndrome and children without Down syndrome and investigate whether there is a significant difference in the burden that is placed on the health care system between these two groups only in respect of the repair of congenital heart disease at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Design. This study is a retrospective case control review. Setting. Red Cross War Memorial Children’s Hospital, Cape Town, South Africa.Subjects. The sample group of 50 Down syndrome children who had received cardiac surgery between January 1998 and June 2003 was compared with a control group of 50 nonsyndromic children who had received cardiac surgery during the same period. Outcome measures. Sex and diagnoses (cardiac and noncardiac), number of days spent in hospital and in ICU, complication rates, re-operation rates, early mortality rates, planned further cardiac surgery. Costs of these outcomes were not quantified in exact monetary terms. Results. There was no significant difference between the two groups in terms of the burden that was placed on the health care system. Similar complication rates, re-operation rates and early mortality rates were recorded for both groups. The Down syndrome group appeared to benefit more from cardiac surgery than the non-Down syndrome group. Conclusion. Denying cardiac surgery to children with Down syndrome does not improve the efficiency of resource allocation. It is therefore not reasonable to suggest that the problem of scarce resources can be ameliorated by discriminating against children with Down syndrome

Sydenham's chorea - clinical and therapeutic update 320 years down the line

Post-streptococcal neuropsychiatric movement disorders (PNM) were first described in the Middle Ages, but today more than 300 years later, confusion remains surrounding the terminology, treatment and monitoring of these conditions. Rheumatic fever is currently the major cause of acquired heart disease among children in South Africa.1 The incidence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) is not declining. Recent figures quote the incidence of rheumatic fever as 0.6 - 0.7/1 000 population in the USA and Japan compared with 15 - 21/1 000 population in Asia and Africa.2 In a study conducted in 1975 in Soweto, South Africa, 12 050 schoolchildren were examined and 19.2/1 000 had rheumatic heart disease.3 A 2002 report from a cardiology workshop highlighted the belief among clinicians that South Africa is currently in the midst of a rheumatic fever epidemic.4,5 Sydenham’s chorea (SC) is a major manifestation of ARF. Accordingly, in the South African context when PNMs are diagnosed, treatment strategies must always include the prevention of RHD

Impact of the Manchester Glaucoma Enhanced Referral Scheme on NHS costs

Objectives: Glaucoma filtering schemes such as the Manchester Glaucoma Enhanced Referral Scheme (GERS) aim to reduce the number of false positive cases referred to Hospital Eye Services. Such schemes can also have wider system benefits, as they may reduce waiting times for other patients. However, previous studies of the cost consequences and wider system benefits of glaucoma filtering schemes are inconclusive. We investigate the cost consequences of the Manchester GERS. Design: Observational study. Methods: A cost analysis from the perspective of the National Health Service (NHS) was conducted using audit data from the Manchester GERS. Results: 2405 patients passed through the Manchester GERS from April 2013 to November 2016. 53.3% were not referred on to Manchester Royal Eye Hospital (MREH). Assuming an average of 2.3 outpatient visits to MREH were avoided for each filtered patient, the scheme saved the NHS approximately £2.76 per patient passing through the scheme. Conclusion: Our results indicate that glaucoma filtering schemes have the potential to reduce false positive referrals and costs to the NHS

Barriers to childhood cataract services across India. A mixed methods study using the Theoretical Domains Framework (TDF) of behaviour change

Purpose : Early identification and presentation for childhood cataract surgery remains a major challenge in developing countries. The main aim of this study was to identify potential barriers to childhood cataract services from the perspective of parents’ and carers’, as a critical step towards achieving the timely uptake of cataract services. Methods : We used a mixed methods explanatory sequential study and interviewed 572 parents/carers attending tertiary hospitals in 8 states across India for their child's cataract surgery. We collected information on barriers to accessing services using a 12-item questionnaire and for each reported barrier, responses recorded on a 5 point scale ranging from “low to high importance”. Based on the quantitative data, in-depth interview questions were prepared and 35 interviews were conducted with randomly selected parents/ carers. Majority of these interviews were conducted at the hospital and /at home for those who did not undergo the surgery. Quantitative questionnaires were completed by the trained interviewer and responses were recorded in a pre-designed format. In-depth interviews were audio taped and transcribed for analysis. Quantitative data were analysed using SPSS 22 while qualitative data were organised with NVivo 11 and a thematic analysis was conducted utilising TDF, an integrative framework of theories. Results : From the 831 responses the 5 most important barriers were: economic (40%; n=222); child too young for surgery (17%; n=97); the problem was not felt as severe (16%; n=90); distance (14.5%; n=83) and no one to accompany to the hospital (9.5%; n=54). In addition, being advised by a local ophthalmologist to delay the surgery was also reported (n=16). Domains identified by the TDF included “Knowledge”, “Beliefs about consequences”, “Intentions”, “Goals”, “Decision processes”, “Environmental context and resources”, “Social influences and emotion”. This comprehensive TDF approach enabled us to understand the parents perceived barriers to access services for the children. Conclusions : Barriers to accessing childhood cataract services include both practical concerns relating to the family’s socio economic status as well as obstacles from the providers. Mapping out the barriers is necessary to design appropriate intervention for achieving positive behaviour change that can have potential social and economic impact

Cerebellar modulation of memory encoding in the periaqueductal grey and fear behaviour

The pivotal role of the periaqueductal grey (PAG) in fear learning is reinforced by the identification of neurons in male rat ventrolateral PAG (vlPAG) that encode fear memory through signalling the onset and offset of an auditory-conditioned stimulus during presentation of the unreinforced conditioned tone (CS+) during retrieval. Some units only display CS+ onset or offset responses, and the two signals differ in extinction sensitivity, suggesting that they are independent of each other. In addition, understanding cerebellar contributions to survival circuits is advanced by the discovery that (i) reversible inactivation of the medial cerebellar nucleus (MCN) during fear consolidation leads in subsequent retrieval to (a) disruption of the temporal precision of vlPAG offset, but not onset responses to CS+, and (b) an increase in duration of freezing behaviour. And (ii) chemogenetic manipulation of the MCN-vlPAG projection during fear acquisition (a) reduces the occurrence of fear-related ultrasonic vocalisations, and (b) during subsequent retrieval, slows the extinction rate of fear-related freezing. These findings show that the cerebellum is part of the survival network that regulates fear memory processes at multiple timescales and in multiple ways, raising the possibility that dysfunctional interactions in the cerebellar-survival network may underlie fear-related disorders and comorbidities

Delay in presentation to hospital for childhood cataract surgery in India

Purpose Cataract is one of the major causes of avoidable visual disability in children and the aim of this study was to investigate the age at which children with cataract present for surgery at tertiary hospitals across India. Methods: A prospective multicenter study collected data from 9 eye hospitals in 8 states in India. All children admitted for cataract surgery between Nov 2015 and March 2016 were considered eligible. Parents were interviewed at the hospital by trained personnel and socio demographic information, age at diagnosis and at surgery and the relevant clinical data were obtained from the medical records. Mean age, age range at surgery were used and performed logistic regression analyses. Results Parents of 751 consecutive cases were interviewed, of which 469(63%) were boys and 548(73%) were from rural areas. Cataract was bilateral in 493 (66%) and unilateral in 258 (34%); of the unilateral cases, 179 (69%) were due to trauma. The mean age at surgery for ‘congenital’ and ‘developmental’ cataract was 48.2±50.9 and 99.7±46.42 months respectively and the mean age was lower in the southern region compared to other regions. Children with 2 or more siblings at home were five times more likely to undergo surgery within 12 months (OR, 4.69; 95% CI: 2.04 – 10.79; p = <0.001). Conclusions Late surgery for childhood cataract remains a major challenge and the factors determining this issue in India are pertinent also to several other countries and need to be addressed for every child with cataract to achieve full visual potential

Evaluation of a minor eye conditions scheme delivered by community optometrists

BACKGROUND: The establishment of minor eye conditions schemes (MECS) within community optometric practices provides a mechanism for the timely assessment of patients presenting with a range of acute eye conditions. This has the potential to reduce waiting times and avoid unnecessary referrals to hospital eye services (HES). OBJECTIVE: To evaluate the clinical effectiveness, impact on hospital attendances and patient satisfaction with a minor eye service provided by community optometrists. METHODS: Activity and outcome data were collected for 12 months in the Lambeth and Lewisham MECS. A patient satisfaction questionnaire was given to patients at the end of their MECS appointment. A retrospective difference-in-differences analysis of hospital activity compared changes in the volume of referrals by general practitioners (GPs) from a period before (April 2011-March 2013) to after (April 2013-March 2015) the introduction of the scheme in Lambeth and Lewisham relative to a neighbouring area (Southwark) where the scheme had not been commissioned. Appropriateness of case management was assessed by consensus using clinical members of the research team. RESULTS: A total of 2123 patients accessed the scheme. Approximately two-thirds of patients (67.5%) were referred by their GP. The commonest reasons for patients attending for a MECS assessment were 'red eye' (36.7% of patients), 'painful white eye' (11.1%) and 'flashes and floaters' (10.2%). A total of 64.1% of patients were managed in optometric practice and 18.9% were referred to the HES; of these, 89.2% had been appropriately referred. First attendances to HES referred by GPs reduced by 26.8% (95% CI -40.5% to -13.1%) in Lambeth and Lewisham compared to Southwark. CONCLUSIONS: The Lambeth and Lewisham MECS demonstrates clinical effectiveness, reduction in hospital attendances and high patient satisfaction and represents a successful collaboration between commissioners, local HES units and primary healthcare providers