148 research outputs found
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Patients’ attitudes and beliefs to presbyopia and its correction
Objective
Presbyopia is the gradual inability to focus near objects with age. This study explores patients’ attitudes and beliefs towards presbyopia including preferred modes of near refractive correction.
Methods
In the United Kingdom, twenty-four volunteers completed an online questionnaire and attended a structured, recorded focus group. Participants’ age ranged between 36 and 48 years, representing a pre-presbyopic and a presbyopic population. Attitudes and beliefs about presbyopia, its significance, and opinions about current refractive correction including multifocal contact lenses were transcribed and coded using content analysis for overarching themes and patterns.
Results
Six participants (25%) were already wearing a near visual correction while 18 (75%) were not. Five key primary themes with clear inter-participant similarities were identified as ‘age-related’ (75%), ‘acceptance’ (50%), clear lack of ‘familiarity with the word presbyopia’ (65%), a mixed/ reluctant attitude ‘towards (multifocal) contact lenses’ (62.5%), and ‘comfort and convenience’ of a presbyopic correction (79%) whereby cost is of less importance.
Conclusion
The need for a reading correction was perceived as a sign of age. Spectacles were the most preferred mode of near vision correction, while comfort and convenience were seen as more important than cost. Patient education about presbyopia is lacking. Multifocal contact lenses are not necessarily the preferred visual correction even if the patient already wears contact lenses for distance
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Smartphone ophthalmoscopy: patient and student practitioner perceptions
It can take several years to become proficient at direct ophthalmoscopy; the instrument’s single eyepiece allows only one individual to view the image at a time, which is considered disadvantageous during teaching. The introduction of smartphone ophthalmoscopes enables groups of teachers and students to view images together which could encourage peer-to-peer learning. In addition, the technology is significantly cheaper than the direct ophthalmoscope. User acceptability and engagement is essential to the success of any (medical) technological innovation. We sought to understand student opinions of a new commercially-available smartphone device for fundus examination, and compare usability to the traditional ophthalmoscope, from the perspective of both student practitioners and patients. Fifty-four undergraduate optometry students with prior experience of the traditional direct ophthalmoscope were asked to examine at least one eye with the D-EYE smartphone ophthalmoscope and also given an opportunity to experience the D-EYE from a patient’s perspective. Minimal instructions were provided and all examinations conducted through undilated pupils. Participants completed an opinion survey to feedback on aspects such as the ease of handling and working distance. Compared to the direct ophthalmoscope, 92% of students preferred the (longer) working distance of the D-EYE; 77% felt it was easier to handle; and 92% preferred the patient experience with the D-EYE. Despite the positive feedback, only 43% of students preferred the D-EYE when assuming the role of the practitioner. Free text responses indicated that students felt the D-EYE may be most useful as a teaching tool. Student opinions indicated that smartphone ophthalmoscopes are an effective training tool for students as an accompaniment to learning the traditional ophthalmoscope method
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The Association between Foveal Morphology and Macular Pigment Spatial Distribution: An Ethnicity Study
Purpose
Macular pigment (MP) spatial distribution varies considerably among individuals. We investigated ethnic variations in MP spatial distribution in relation to foveal architecture.
Methods
We measured MP optical density (MPOD) using heterochromatic flicker photometry (MAP test, City, University of London) in 76 white, 80 South Asian and 70 black volunteers (18 to 39 years). MPOD spatial profiles were classified objectively as exponential, ring-like or central dip, based on deviations away from an exponential fit. Measurements including total retinal thickness (RT), inner retinal layer (IRL), inner and outer plexiform layer (IPL and OPL) thickness, foveal width and foveal pit slope were taken from Spectralis SD-OCT (Heidelberg, Germany) scans.
Results
Integrated MPOD up to 1.8° (MPODint) was higher in South Asian (0.84±0.26) and black (0.84±0.31) than whites (0.63±0.24, P0.05).
Conclusion
We report a significant difference in the amount and distribution of MP between ethnicities that is not explained by variations in foveal morphology
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Diabetes mellitus and the eye: axial length
Background and aims: The refractive error of the eye is dependent on its axial length. Refractive error is known to fluctuate significantly in poorly controlled diabetic patients. Recently it has been reported that human eyes fluctuate in axial length during the day. However, this change is not detectable in all subjects, suggesting physiological influences such as diet. The purpose of this study was to investigate fluctuations in axial length and blood glucose levels (BGLs) in diabetic patients and control subjects, using partial coherence interferometry.
Material and methods: Periodic axial length measurements were taken with an IOLMaster (Zeiss, Oberkochen, Germany) in 21 type 2 diabetic subjects (age 56 ± 11 years), 19 type 1 diabetic subjects (age 38 ± 15 years) and 18 non-diabetic controls (age 46 ± 22 years). Additionally, BGLs were measured using a HemoCue Beta glucose analyser (HemoCue, Ängelholm, Sweden). Measurements were taken between 8AM and 8PM at approximately two hourly intervals. The ocular length variability was mapped against time of day and related to BGLs, age, and the degree of diabetic retinopathy.
Results: Axial length variations were found to be significant with time (ANOVA, P=.003) and there was a significant effect for the interaction between group and time of day (ANOVA, P.05)
Conclusion: Axial length varies throughout the day in diabetic and control subjects; however, this change does not appear to be significant in every individual. The data suggest a maximum axial length value in the afternoon. Changes in axial length from baseline did not correlate with BGLs, age, or the degree of diabetic retinopathy. Therefore, blood glucose levels may not be the main physiological influence in axial length fluctuations
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Evaluating a new objective grading software for conjunctival hyperaemia
Background/ Aims: Standardised numeric grading scales are used in ophthalmic practice to improve consistency between clinicians in recording the severity of ocular conditions and to facilitate the monitoring of such changes. We investigated the intra- and inter-observer grading reliability and the agreement between subjective Cornea and Contact Lens Research Unit (CCLRU) and Efron grading scales as well as a new Advanced Ophthalmic Systems (AOS) software which uses an objective approach to grading conjunctival hyperaemia.
Methods: One experienced observer graded n = 30 bulbar and n = 26 palpebral conjunctival hyperaemia images to 0.1 increments. Masked grading of randomised images was undertaken for all three methods, on two separate occasions. The agreement within and between the grading methods was assessed between sessions, and compared to the results of a novice observer.
Results: There were no statistically significant differences (P > 0.05) between test and retest values. However, repeatability in the grading estimates of both bulbar and palpebral conjunctival hyperaemia was improved using the AOS grading method (R2 = 0.998; Coefficient of Repeatability CoR 0.10–0.13), compared to Efron (R2 = 0.926; CoR 0.62) and CCLRU (R2 = 0.885–0.911; CoR 0.50–0.78). Intraclass coefficient correlations (ICC) improved inter-observer agreement using objective (> 0.995) versus subjective methods (0.853–0.959).
Conclusion: These subjective and objective grading methods are not interchangeable. Due to the excellent repeatability and improved agreement between experienced and novice observers, the objective grading method provides a more consistent approach when grading ocular abnormalities and may achieve greater reliability in record keeping and clinical monitoring in the future
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Nutritional and smoking advice recalled by patients attending a UK age-related macular degeneration clinic
Background: Age-related macular degeneration (AMD) is responsible for half of registered visual impairment in the UK. The Royal College of Ophthalmologists recommends providing guidance to people with AMD regarding smoking, diet, and nutritional supplements. The aim of this study was to investigate lifestyle advice recalled by patients with neovascular AMD (nAMD). Methods: The study took place at a UK hospital outpatients' clinic. Eligible patients with unilateral nAMD were presented with a survey about lifestyle advice provision. Results: Of 248 respondents, only 39.9% remembered receiving advice regarding diet at the hospital. Only 24.2% of respondents recalled receiving advice regarding nutritional supplements, and only 19.8% of respondents started taking daily supplements as a result of their AMD. The most prevalent reason for not taking supplements amongst those advised to do so was lack of understanding of how it would help their eyes. Nearly 13% of the sample reported currently smoking, 53.1% of which reported that they were advised to stop smoking when diagnosed with AMD. Conclusion: The findings suggest that it would be beneficial to review the provision of lifestyle advice to patients attending AMD outpatients' clinics, and to consider whether advice is being provided in an optimal format for later recall
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Difference in corneal asphericity and sagittal height between emmetropes and myopes
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Ethnic variations in preferred retinal locus of fixation using Optical Coherence Tomography
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018
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