203 results on '"Wormald, R"'
Search Results
2. Novel ENT live telehealth and live video-otoscopy clinics in remote Australia: outcomes and comparisons to traditional clinic models.
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O'Neil LM, O'Neill M, Whelan F, Leahy T, Wormald R, Hinton-Bayre AD, Ghandour J, and Kuthubutheen J
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- Humans, Australia, Otoscopy, Retrospective Studies, Australian Aboriginal and Torres Strait Islander Peoples, Telemedicine
- Abstract
Background: Coronavirus disease 2019 challenged the delivery of healthcare in Australia, disproportionately impacting vulnerable patients, including Aboriginal and/or Torres Strait Islander peoples and those living in remote regions. The otolaryngology service provided to remote Western Australia adapted to these barriers by altering clinical consultations to a digital model., Methods: A review was undertaken of patients in regional Western Australia. Demographics and clinical outcomes from 20 live telehealth clinics were retrospectively reviewed and compared to 16 face-to-face clinics., Results: The demographics of patients reviewed in both live telehealth and face-to-face clinics were similar, except for a larger proportion of Aboriginal and/or Torres Strait Islander patients utilising telehealth. The outcomes of patients reviewed through each model of care were comparable. Live video-otoscopy provided diagnostic quality images in 92 per cent of cases., Conclusion: The findings of our review suggest that, despite its limitations, a large proportion of ENT patients may be safely assessed through a live telehealth model.
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- 2024
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3. Bacillus-based probiotic cleansers reduce the formation of dry biofilms on common hospital surfaces.
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Wormald R, Humphreys PN, Charles CJ, and Rout SP
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- Staphylococcus aureus, Biofilms, Hospitals, Bacillus, Probiotics
- Abstract
In the absence of liquid suspension, dry biofilms can form upon hard surfaces within a hospital environment, representing a healthcare-associated infection risk. Probiotic cleansers using generally recognized as safe organisms, such as those of the Bacillus genus, represent a potential strategy for the reduction of dry biofilm bioburden. The mechanisms of action and efficacy of these cleaners are, however, poorly understood. To address this, a preventative dry biofilm assay was developed using steel, melamine, and ceramic surfaces to assess the ability of a commercially available Bacillus spp. based probiotic cleanser to reduce the surface bioburden of Escherichia coli and Staphylococcus aureus. Via this assay, phosphate-buffered saline controls were able to generate dry biofilms within 7 days of incubation, with the application of the probiotic cleanser able to prevent >97.7% of dry biofilm formation across both pathogen analogs and surface types. Further to this, surfaces treated with the probiotic mixture alone also showed a reduction in dry biofilm across both pathogen and surface types. Confocal laser scanning microscopy imaging indicated that the probiotic bacteria were able to germinate and colonize surfaces, likely forming a protective layer upon these hard surfaces., (© 2023 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.)
- Published
- 2023
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4. Survival and prognosis of surgical head and neck cancer patients aged 80 years and older.
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Sobhi S, Wormald R, Hollitt S, and Flukes S
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Introduction: Elderly patients (≥80 years of age) with head and neck cancer (HNC) can prove a management challenge due to concerns regarding their suitability for surgery. This study aims to describe the characteristics and outcomes of elderly patients undergoing HNC surgery., Methods: A retrospective review of elderly patients undergoing HNC surgery was conducted. Demographics, comorbidities, tumor characteristics, surgical procedure type, postoperative complications, and disposition were reviewed. Overall survival (OS) in the elderly cohort was compared against younger patients (<80 years)., Results: A total of 595 patients were included, of whom 86 were aged >80 years (71% male; mean age 84.8, range 80.0-98.8 years). The overall complication rate was 43%. When compared with younger patients ( n = 509), elderly patients had reduced OS (risk ratio: 2.0, 95% CI: 1.3-3.2), higher 90-day mortality (8.1% vs. 2.3%, p = .005), and lower 5-year survival (43.5% vs. 64.1%, p < .001). However, survival was comparable to age-specific life expectancy. There was no difference in OS, 90-day mortality, and 5-year survival when comparing >85 ( n = 33) and 80-85 ( n = 53) age groups., Conclusions: Chronological age alone should not negatively influence decision-making in HNC surgery the elderly. With careful preoperative selection and optimization, surgery can be performed at acceptable risk with good outcomes in elderly patients., Level of Evidence: IV., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)
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- 2023
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5. Toward Universal Eye Health Coverage-Key Outcomes of the World Health Organization Package of Eye Care Interventions: A Systematic Review.
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Keel S, Lingham G, Misra N, Block S, Bourne R, Calonge M, Cheng CY, Friedman DS, Furtado JM, Khanna R, Mariotti S, Mathenge W, Matoto E, Müeller A, Rabiu M, Rasengane T, Resnikoff S, Wormald R, Yasmin S, Zhao J, Evans JR, and Cieza A
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- Humans, World Health Organization, Universal Health Insurance, Health Promotion
- Abstract
Importance: Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed., Objective: To describe the key outcomes of the PECI development., Evidence Review: A standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review., Findings: Fifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI., Conclusions and Relevance: This systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.
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- 2022
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6. Differences in the Surgical Outcomes of Glaucoma Surgery in Patients of African Caribbean Descent.
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Nagar AM, Maghsoudlou P, Wormald R, Barton K, Hysi P, and Lim KS
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- Humans, Retrospective Studies, Prospective Studies, Treatment Outcome, Caribbean Region epidemiology, Intraocular Pressure, Trabeculectomy methods, Glaucoma surgery, Glaucoma drug therapy
- Abstract
Purpose: People of African Caribbean Descent (ACD) have a higher prevalence of glaucoma compared to people of European Descent (ED) and there is uncertainty if treatment outcomes are equivalent between the two groups. To assess surgical failure rates comparing ACD with ED focusing on trabeculectomy, aqueous shunt implantation, non-penetrating filtering surgery (NPFS), and minimally invasive glaucoma surgery (MIGS) by performing a systematic review in accordance with the PRISMA guidelines and to determine whether there is any evidence in to show a difference in success rates based on race., Methods: A systematic review of articles using the CENTRAL, Ovid MEDLINE, PubMed, EMBASE, and ClinicalTrials.gov databases was completed. Additional studies were identified by contacting clinical experts and searching bibliographies. All retrospective and prospective studies on trabeculectomy, aqueous shunt implantation, NPFS, and MIGS that included at least 20% ACD were included. Two review authors independently screened search results for eligibility and inclusion and extracted the data using pre-determined fields., Results: A total of 76 studies were identified for inclusion in the review. Glaucoma surgical outcomes in ACD appear to be poorer compared to ED overall, particularly for trabeculectomy. Data on NPFS are limited, but the studies completed thus far demonstrate surprisingly good results for ACD, particularly when compared to ED, who have significantly lower pre-operative IOPs. Evidence from studies investigating aqueous shunts does not suggest that ACD have poorer outcomes than ED. There is not enough data on MIGS to provide a significant conclusion., Conclusion: In a population where trabeculectomy may no longer be the gold standard, sufficiently powered studies assessing surgical outcomes in aqueous shunts, NPFS, and MIGS are needed to guide clinicians.
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- 2022
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7. Laser trabeculoplasty for open-angle glaucoma and ocular hypertension.
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Rolim-de-Moura CR, Paranhos A Jr, Loutfi M, Burton D, Wormald R, and Evans JR
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- Argon therapeutic use, Humans, Glaucoma surgery, Glaucoma, Open-Angle drug therapy, Glaucoma, Open-Angle surgery, Ocular Hypertension etiology, Ocular Hypertension surgery, Optic Nerve Diseases etiology, Optic Nerve Diseases surgery, Trabeculectomy adverse effects, Trabeculectomy methods
- Abstract
Background: Open-angle glaucoma (OAG) is an important cause of blindness worldwide. Laser trabeculoplasty, a treatment modality, still does not have a clear position in the treatment sequence., Objectives: To assess the effects of laser trabeculoplasty for treating OAG and ocular hypertension (OHT) when compared to medication, glaucoma surgery or no intervention. We also wished to compare the effectiveness of different laser trabeculoplasty technologies for treating OAG and OHT., Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2021, Issue 10); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; LILACS, ClinicalTrials.gov and the WHO ICTRP. The date of the search was 28 October 2021. We also contacted researchers in the field., Selection Criteria: We included randomised controlled trials (RCTs) comparing laser trabeculoplasty with no intervention, with medical treatment, or with surgery in people with OAG or OHT. We also included trials comparing different types of laser trabeculoplasty technologies., Data Collection and Analysis: We used standard methods expected by Cochrane. Two authors screened search results and extracted data independently. We considered the following outcomes at 24 months: failure to control intraocular pressure (IOP), failure to stabilise visual field progression, failure to stabilise optic neuropathy progression, adverse effects, quality of life, and costs. We graded the 'certainty' of the evidence using GRADE., Main Results: We included 40 studies (5613 eyes of 4028 people) in this review. The majority of the studies were conducted in Europe and in the USA. Most of the studies were at risk of performance and/or detection bias as they were unmasked. None of the studies were judged as having low risk of bias for all domains. We did not identify any studies of laser trabeculoplasty alone versus no intervention. Laser trabeculoplasty versus medication Fourteen studies compared laser trabeculoplasty with medication in either people with primary OAG (7 studies) or primary or secondary OAG (7 studies); five of the 14 studies also included participants with OHT. Six studies used argon laser trabeculoplasty and eight studies used selective laser trabeculoplasty. There was considerable clinical and methodological diversity in these studies leading to statistical heterogeneity in results for the primary outcome "failure to control IOP" at 24 months. Risk ratios (RRs) ranged from 0.43 in favour of laser trabeculoplasty to 1.87 in favour of medication (5 studies, I
2 = 89%). Studies of argon laser compared with medication were more likely to show a beneficial effect compared with studies of selective laser (test for interaction P = 0.0001) but the argon laser studies were older and the medication comparator group in those studies may have been less effective. We considered this to be low-certainty evidence because the trials were at risk of bias (they were not masked) and there was unexplained heterogeneity. There was evidence from two studies (624 eyes) that argon laser treatment was associated with less failure to stabilise visual field progression compared with medication (7% versus 11%, RR 0.70, 95% CI 0.42 to 1.16) at 24 months and one further large recent study of selective laser also reported a reduced risk of failure at 48 months (17% versus 26%) RR 0.65, 95% CI 0.52 to 0.81, 1178 eyes). We judged this outcome as moderate-certainty evidence, downgrading for risk of bias. There was only very low-certainty evidence on optic neuropathy progression. Adverse effects were more commonly seen in the laser trabeculoplasty group including peripheral anterior synechiae (PAS) associated with argon laser (32% versus 26%, RR 11.74, 95% CI 5.94 to 23.22; 624 eyes; 2 RCTs; low-certainty evidence); 5% of participants treated with laser in three studies of selective laser group had early IOP spikes (moderate-certainty evidence). One UK-based study provided moderate-certainty evidence that laser trabeculoplasty was more cost-effective. Laser trabeculoplasty versus trabeculectomy Three studies compared laser trabeculoplasty with trabeculectomy. All three studies enrolled participants with OAG (primary or secondary) and used argon laser. People receiving laser trabeculoplasty may have a higher risk of uncontrolled IOP at 24 months compared with people receiving trabeculectomy (16% versus 8%, RR 2.12, 95% CI 1.44 to 3.11; 901 eyes; 2 RCTs). We judged this to be low-certainty evidence because of risk of bias (trials were not masked) and there was inconsistency between the two trials (I2 = 68%). There was limited evidence on visual field progression suggesting a higher risk of failure with laser trabeculoplasty. There was no information on optic neuropathy progression, quality of life or costs. PAS formation and IOP spikes were not reported but in one study trabeculectomy was associated with an increased risk of cataract (RR 1.78, 95% CI 1.46 to 2.16) (very low-certainty evidence)., Authors' Conclusions: Laser trabeculoplasty may work better than topical medication in slowing down the progression of open-angle glaucoma (rate of visual field loss) and may be similar to modern eye drops in controlling eye pressure at a lower cost. It is not associated with serious unwanted effects, particularly for the newer types of trabeculoplasty, such as selective laser trabeculoplasty., (Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)- Published
- 2022
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8. Grand Challenges in global eye health: a global prioritisation process using Delphi method.
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Ramke J, Evans JR, Habtamu E, Mwangi N, Silva JC, Swenor BK, Congdon N, Faal HB, Foster A, Friedman DS, Gichuhi S, Jonas JB, Khaw PT, Kyari F, Murthy GVS, Wang N, Wong TY, Wormald R, Yusufu M, Taylor H, Resnikoff S, West SK, and Burton MJ
- Subjects
- Africa South of the Sahara, Child, Delphi Technique, Female, Health Services Accessibility, Humans, Male, Blindness, Global Health
- Abstract
Background: We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations., Methods: Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists., Findings: Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity., Interpretation: This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges., Funding: The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission., Translations: For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section., Competing Interests: MJB reports grants (in support of the work of the Lancet Global Health Commission) from The Wellcome Trust, The Queen Elizabeth Diamond Jubilee Trust, Sightsavers, The Fred Hollows Foundation, The British Council for the Prevention of Blindness, Moorfields Eye Charity, The Seva Foundation, and Christian Blind Mission during the conduct of the study. NC reports personal fees from Belkin Vision. DSF reports personal fees from W L Gore, Bausch and Lomb, Life Biosciences, Thea, and iDx outside of the submitted work; and is a member of the Board of Orbis International. TYW reports grants from Allergan, Bayer, Boehringer Ingelheim, Eden Ophthalmic, Genentech, Iveric Bio, Merck, Novartis, Oxurion (formerly ThromboGenics), Roche, Samsung, Shanghai Henlius, Zhaoke Pharmaceutical, and Aldropika Therapeutics, and is co-founder of start-up companies Plano and EyRiS. PTK reports stockholding for Radiance Therapeutics and Optceutics; personal fees from Aerie, Alcon, AstraZeneca, Bausch + Lomb, Genetech, Novartis, Pfizer, and Sanofi-Aventis outside of the submitted work; being a board member of Moorfields Eye Hospital; and having a patent pending for Biochannel Device. HT reports leadership roles for the International Council of Ophthalmology and the Ophthalmology Foundation (unpaid roles). SKW reports board membership (unpaid) of Christian Blind Mission-USA. All other authors declare no competing interests., (© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.)
- Published
- 2022
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9. Lateral temporal bone resection for cutaneous carcinomas of the external auditory canal and peri-auricular region.
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Leedman S, Wormald R, and Flukes S
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Objectives: To evaluate the outcomes for patients after lateral temporal bone resection surgery for cutaneous squamous cell carcinoma and basal cell carcinoma, and to ascertain predictors of survival and treatment failure., Methods: A retrospective review was conducted of the medical records for all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma or basal cell carcinoma between 2007 and 2019 in Western Australia., Results: Thirty-seven patients underwent lateral temporal bone resection surgery. Median follow-up duration was 22 months. Twenty-five patients had squamous cell carcinoma and 12 had basal cell carcinoma. The overall survival rate at two years for patients with squamous cell carcinoma was 68.5 per cent. Pre-operative facial nerve involvement (determined via clinical or radiological evidence) was identified as a predictor of mortality (hazard ratio = 3.411, p = 0.006), with all patients dying before two years post-operatively. Locoregional tumour control was achieved in 81 per cent of cases (n = 30)., Conclusion: Lateral temporal bone resection offers acceptable local control rates and survival outcomes. Caution should be used in offering this surgery to patients with clinical or radiological evidence of facial nerve involvement because of the relatively poorer survival outcomes in this subgroup.
- Published
- 2021
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10. Minimally Invasive Glaucoma Surgical Techniques for Open-Angle Glaucoma: An Overview of Cochrane Systematic Reviews and Network Meta-analysis.
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Bicket AK, Le JT, Azuara-Blanco A, Gazzard G, Wormald R, Bunce C, Hu K, Jayaram H, King A, Otárola F, Nikita E, Shah A, Stead R, Tóth M, and Li T
- Subjects
- Humans, Intraocular Pressure, Network Meta-Analysis, Randomized Controlled Trials as Topic, Systematic Reviews as Topic, Cataract complications, Glaucoma surgery, Glaucoma, Open-Angle complications, Glaucoma, Open-Angle surgery, Trabeculectomy methods
- Abstract
Importance: Glaucoma affects more than 75 million people worldwide. Intraocular pressure (IOP)-lowering surgery is an important treatment for this disease. Interest in reducing surgical morbidity has led to the introduction of minimally invasive glaucoma surgeries (MIGS). Understanding the comparative effectiveness and safety of MIGS is necessary for clinicians and patients., Objective: To summarize data from randomized clinical trials of MIGS for open-angle glaucoma, which were evaluated in a suite of Cochrane reviews., Data Sources: The Cochrane Database of Systematic Reviews including studies published before June 1, 2021., Study Selection: Reviews of randomized clinical trials comparing MIGS with cataract extraction alone, other MIGS, traditional glaucoma surgery, laser trabeculoplasty, or medical therapy., Data Extraction and Synthesis: Data were extracted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines by one investigator and confirmed by a second. Methodologic rigor was assessed using the AMSTAR 2 appraisal tool and random-effects network meta-analyses were conducted., Main Outcomes and Measures: The proportion of participants who did not need to use medication to reduce intraocular pressure (IOP) postsurgery (drop-free). Outcomes were analyzed at short-term (<6 months), medium-term (6-18 months), and long-term (>18 months) follow-up., Results: Six eligible Cochrane reviews were identified discussing trabecular bypass with iStent or Hydrus microstents, ab interno trabeculotomy with Trabectome, subconjunctival and supraciliary drainage devices, and endoscopic cyclophotocoagulation. Moderate certainty evidence indicated that adding a Hydrus safely improved the likelihood of drop-free glaucoma control at medium-term (relative risk [RR], 1.6; 95% CI, 1.4 to 1.8) and long-term (RR, 1.6; 95% CI, 1.4 to 1.9) follow-up and conferred 2.0-mm Hg (95% CI, -2.7 to -1.3 mm Hg) greater IOP reduction at long-term follow-up, compared with cataract surgery alone. Adding an iStent also safely improved drop-free disease control compared with cataract surgery alone (RR, 1.4; 95% CI, 1.2 to 1.6), but the short-term IOP-lowering effect of the iStent was not sustained. Addition of a CyPass microstent improved drop-free glaucoma control compared with cataract surgery alone (RR, 1.3; 95% CI, 1.1 to 1.5) but was associated with an increased risk of vraision loss. Network meta-analyses supported the direction and magnitude of these results., Conclusions and Relevance: Based on data synthesized in Cochrane reviews, some MIGS may afford patients with glaucoma greater drop-free disease control than cataract surgery alone. Among the products currently available, randomized clinical trial data associate the Hydrus with greater drop-free glaucoma control and IOP lowering than the iStent; however, these effect sizes were small.
- Published
- 2021
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11. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020.
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Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, Ah Tong BAM, Arunga S, Bachani D, Bascaran C, Bastawrous A, Blanchet K, Braithwaite T, Buchan JC, Cairns J, Cama A, Chagunda M, Chuluunkhuu C, Cooper A, Crofts-Lawrence J, Dean WH, Denniston AK, Ehrlich JR, Emerson PM, Evans JR, Frick KD, Friedman DS, Furtado JM, Gichangi MM, Gichuhi S, Gilbert SS, Gurung R, Habtamu E, Holland P, Jonas JB, Keane PA, Keay L, Khanna RC, Khaw PT, Kuper H, Kyari F, Lansingh VC, Mactaggart I, Mafwiri MM, Mathenge W, McCormick I, Morjaria P, Mowatt L, Muirhead D, Murthy GVS, Mwangi N, Patel DB, Peto T, Qureshi BM, Salomão SR, Sarah V, Shilio BR, Solomon AW, Swenor BK, Taylor HR, Wang N, Webson A, West SK, Wong TY, Wormald R, Yasmin S, Yusufu M, Silva JC, Resnikoff S, Ravilla T, Gilbert CE, Foster A, and Faal HB
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- Advisory Committees organization & administration, Blindness economics, Blindness etiology, Cost of Illness, Eye Diseases complications, Eye Diseases diagnosis, Eye Diseases epidemiology, Global Burden of Disease economics, Health Services Accessibility economics, Humans, Quality of Health Care economics, Quality of Health Care organization & administration, Quality of Life, Blindness prevention & control, Eye Diseases therapy, Global Health, Health Services Accessibility organization & administration, Sustainable Development
- Published
- 2021
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12. Visual Field Outcomes from the Multicenter, Randomized Controlled Laser in Glaucoma and Ocular Hypertension Trial (LiGHT).
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Wright DM, Konstantakopoulou E, Montesano G, Nathwani N, Garg A, Garway-Heath D, Crabb DP, Gazzard G, Adeleke M, Ambler G, Barton K, Bourne R, Broadway D, Bunce C, Buszewicz M, Crabb D, Davis A, Garg A, Garway-Heath D, Gazzard G, Hornan D, Hunter R, Jayaram H, Jiang Y, Konstantakopoulou E, Lim S, Liput J, Manners T, Montesano G, Morris S, Nathwani N, Ometto G, Rubin G, Strouthidis N, Vickerstaff V, Wilson S, Wormald R, Wright D, and Zhu H
- Subjects
- Disease Progression, Female, Glaucoma, Open-Angle surgery, Humans, Male, Middle Aged, Ocular Hypertension physiopathology, Treatment Outcome, Glaucoma, Open-Angle physiopathology, Intraocular Pressure physiology, Laser Therapy methods, Lasers, Solid-State therapeutic use, Trabeculectomy methods, Visual Acuity, Visual Fields physiology
- Abstract
Purpose: To compare visual field outcomes of ocular hypertensive and glaucoma patients treated first with medical therapy with those treated first with selective laser trabeculoplasty (SLT)., Design: Secondary analysis of patients from the Laser in Glaucoma and Ocular Hypertension study, a multicenter randomized controlled trial., Participants: Three hundred forty-four patients (588 eyes) treated first with medical therapy and 344 patients (590 eyes) treated first with SLT., Methods: Visual fields (VFs) were measured using standard automated perimetry and arranged in series (median length and duration, 9 VFs over 48 months). Hierarchical linear models were used to estimate pointwise VF progression rates, which were then averaged to produce a global progression estimate for each eye. Proportions of points and patients in each treatment group with fast (<-1 dB/year) or moderate (<-0.5 dB/year) progression were compared using log-binomial regression., Main Outcome Measures: Pointwise and global progression rates of total deviation (TD) and pattern deviation (PD)., Results: A greater proportion of eyes underwent moderate or fast TD progression in the medical therapy group compared with the SLT group (26.2% vs. 16.9%; risk ratio [RR], 1.55; 95% confidence interval [CI], 1.23-1.93; P < 0.001). A similar pattern was observed for pointwise rates (medical therapy, 26.1% vs. SLT, 19.0%; RR, 1.37; 95% CI, 1.33-1.42; P < 0.001). A greater proportion of pointwise PD rates were categorized as moderate or fast in the medical therapy group (medical therapy, 11.5% vs. SLT, 8.3%; RR, 1.39; 95% CI, 1.32-1.46; P < 0.001). No statistical difference was found in the proportion of eyes that underwent moderate or fast PD progression (medical therapy, 9.9% vs. SLT, 7.1%; RR, 1.39; 95% CI, 0.95, 2.03; P = 0.0928)., Conclusions: A slightly larger proportion of ocular hypertensive and glaucoma patients treated first with medical therapy underwent rapid VF progression compared with those treated first with SLT., (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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13. Strengthening the integration of eye care into the health system: methodology for the development of the WHO package of eye care interventions.
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Keel S, Evans JR, Block S, Bourne R, Calonge M, Cheng CY, Friedman DS, Furtado JM, Khanna RC, Mathenge W, Mariotti S, Matoto E, Müller A, Rabiu MM, Rasengane T, Zhao J, Wormald R, and Cieza A
- Abstract
Objective: To describe the rational for, and the methods that will be employed to develop, the WHO package of eye care interventions (PECI)., Methods and Analysis: The development of the package will be conducted in four steps: (1) selection of eye conditions (for which interventions will be included in the package) based on epidemiological data on the causes of vision impairment and blindness, prevalence estimates of eye conditions and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from clinical practice guidelines and high-quality systematic reviews by a technical working group; (3) expert agreement on the inclusion of eye care interventions in the package and the description of resources required for the provision of the selected interventions; and (4) peer review. The project will be led by the WHO Vision Programme in collaboration with Cochrane Eyes and Vision. A Technical Advisory Group, comprised of public health and clinical experts in the field, will provide technical input throughout all stages of development., Results: After considering the feedback of Technical Advisory Group members and reviewing-related evidence, a final list of eye conditions for which interventions will be included in the package has been collated., Conclusion: The PECI will support Ministries of Health in prioritising, planning, budgeting and integrating eye care interventions into health systems. It is anticipated that the PECI will be available for use in 2021., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2020
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14. Efficacy of Repeat Selective Laser Trabeculoplasty in Medication-Naive Open-Angle Glaucoma and Ocular Hypertension during the LiGHT Trial.
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Garg A, Vickerstaff V, Nathwani N, Garway-Heath D, Konstantakopoulou E, Ambler G, Bunce C, Wormald R, Barton K, Gazzard G, Adeleke M, Ambler G, Barton K, Bourne R, Broadway D, Bunce C, Buszewicz M, Crabb D, Davis A, Garg A, Garway-Heath D, Gazzard G, Hornan D, Hunter R, Jayaram H, Jiang Y, Konstantakopoulou E, Lim S, Liput J, Manners T, Montesano G, Morris S, Nathwani N, Ometto G, Rubin G, Strouthidis N, Vickerstaff V, Wilson S, Wormald R, Wright D, and Zhu H
- Subjects
- Aged, Antihypertensive Agents therapeutic use, Disease Progression, Double-Blind Method, Female, Glaucoma, Open-Angle physiopathology, Humans, Intraocular Pressure physiology, Lasers, Solid-State, Male, Middle Aged, Ocular Hypertension physiopathology, Ocular Hypertension surgery, Prospective Studies, Reoperation, Tonometry, Ocular, Treatment Outcome, Glaucoma, Open-Angle surgery, Laser Therapy methods, Trabecular Meshwork surgery, Trabeculectomy methods
- Abstract
Purpose: To determine the efficacy of repeat selective laser trabeculoplasty (SLT) in medication-naive open-angle glaucoma (OAG) and ocular hypertensive (OHT) patients requiring repeat treatment for early to medium-term failure during the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial., Design: Post hoc analysis of SLT treatment arm of a multicenter prospective randomized controlled trial., Participants: Treatment-naive OAG or OHT requiring repeat 360-degree SLT within 18 months. Retreatment was triggered by predefined IOP and disease-progression criteria (using objective individualized target IOPs)., Methods: After SLT at baseline, patients were followed for a minimum of 18 months after second (repeat) SLT. A mixed-model analysis was performed with the eye as the unit of analysis, with crossed random effects to adjust for correlation between fellow eyes and repeated measures within eyes. Kaplan-Meier curves plot the duration of effect., Main Outcome Measures: Initial (early) IOP lowering at 2 months and duration of effect after initial and repeat SLT., Results: A total of 115 eyes of 90 patients received repeat SLT during the first 18 months of the trial. Pretreatment IOP before initial SLT was significantly higher than before retreatment IOP of repeat SLT (mean difference, 3.4 mmHg; 95% confidence interval [CI], 2.6-4.3 mmHg; P < 0.001). Absolute IOP reduction at 2 months was greater after initial SLT compared with repeat SLT (mean difference, 1.0 mmHg; 95% CI, 0.2-1.8 mmHg; P = 0.02). Adjusted absolute IOP reduction at 2 months (adjusting for IOP before initial or repeat laser) was greater after repeat SLT (adjusted mean difference, -1.1 mmHg, 95% CI, -1.7 to -0.5 mmHg; P = 0.001). A total of 34 eyes were early failures (retreatment 2 months after initial SLT) versus 81 later failures (retreatment >2 months after initial SLT). No significant difference in early absolute IOP reduction at 2 months after repeat SLT was noted between early and later failures (mean difference, 0.3 mmHg; 95% CI, -1.1 to 1.8 mmHg; P = 0.655). Repeat SLT maintained drop-free IOP control in 67% of 115 eyes at 18 months, with no clinically relevant adverse events., Conclusions: These exploratory analyses demonstrate that repeat SLT can maintain IOP at or below target IOP in medication-naive OAG and OHT eyes requiring retreatment with at least an equivalent duration of effect to initial laser., (Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.)
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- 2020
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15. Systematic reviews and randomised controlled trials on open angle glaucoma.
- Author
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Wormald R, Virgili G, and Azuara-Blanco A
- Subjects
- Humans, Randomized Controlled Trials as Topic, Glaucoma, Open-Angle therapy
- Abstract
Evidence for the effectiveness of interventions to prevent the progression of optic nerve damage in open angle glaucoma has evolved over the last 25 years. We describe that evolution through the systematic reviews on various aspects of the topic and how those reviews have highlighted the need for new trials. Though we can be confident that lowering pressure does indeed reduce the risk of progression, we still lack good evidence on the comparative effectiveness of different treatments not so much on lowering pressure but on preventing progression of the disease. This is true for different medicines, types of laser and especially for different surgical interventions. As always there is a need for more research, but this needs to be focussed on key uncertainties using core outcome sets which avoid research waste. Ultimately, our guidelines can be based on sound and comprehensive evidence of effectiveness.
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- 2020
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16. Primary Selective Laser Trabeculoplasty for Open-Angle Glaucoma and Ocular Hypertension: Clinical Outcomes, Predictors of Success, and Safety from the Laser in Glaucoma and Ocular Hypertension Trial.
- Author
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Garg A, Vickerstaff V, Nathwani N, Garway-Heath D, Konstantakopoulou E, Ambler G, Bunce C, Wormald R, Barton K, and Gazzard G
- Subjects
- Aged, Antihypertensive Agents therapeutic use, Female, Glaucoma, Open-Angle drug therapy, Glaucoma, Open-Angle physiopathology, Humans, Intraocular Pressure physiology, Male, Middle Aged, Ocular Hypertension drug therapy, Ocular Hypertension physiopathology, Ocular Hypertension surgery, Prospective Studies, Treatment Outcome, Glaucoma, Open-Angle surgery, Laser Therapy methods, Lasers, Solid-State therapeutic use, Trabecular Meshwork surgery, Trabeculectomy methods
- Abstract
Purpose: To report clinical efficacy, predictors of success, and safety of primary selective laser trabeculoplasty (SLT) used in treatment-naive patients with open-angle glaucoma (OAG) or ocular hypertension (OHT)., Design: Post hoc analysis of a multicenter, prospective, randomized, controlled trial., Participants: Treatment-naive patients with OAG or OHT., Methods: Patients randomized to SLT or topical medication and treated to predefined target intraocular pressures (IOPs) requiring ≥20% IOP reduction from baseline for all disease severity levels., Outcome Measures: Initial (early) absolute IOP-lowering at 2 months. Achievement of drop-free disease-control: meeting target IOP without disease progression or need for additional topical medication over 36 months after SLT. Predictors of early absolute IOP-lowering and drop-free disease-control after single initial SLT. Frequency of laser-related complications., Results: A total of 611 eyes (195 OHT and 416 OAG) of 355 patients received SLT, and 622 eyes (185 OHT and 437 OAG) of 362 patients received topical medication at baseline. Early absolute IOP-lowering after SLT was no different between OHT and OAG eyes (adjusted mean difference = -0.05 mmHg; 95% confidence interval [CI], -0.6 to 0.5 mmHg; P = 0.85). No difference was noted in early absolute IOP-lowering between topical medication and primary SLT (adjusted mean difference = -0.1 mmHg; 95% CI, -0.6 to 0.4 mmHg; P = 0.67). Early absolute IOP-lowering with primary SLT was positively associated with baseline IOP (coefficient 0.58; 95% CI, 0.53-0.63; P < 0.001) and negatively with female gender (coefficient -0.63; 95% CI, -1.23 to -0.02; P = 0.04). At 36 months, 536 eyes (87.7% of 611 eyes) of 314 patients (88.5% of 355 patients) were available for analysis. Some 74.6% of eyes (400 eyes) treated with primary SLT achieved drop-free disease-control at 36 months; 58.2% (312 eyes) after single SLT. Total SLT power and 2-month IOP were predictors of drop-free disease-control at 36 months after single SLT. Six eyes of 6 patients experienced immediate post-laser IOP spike (>5 mmHg from pretreatment IOP) with 1 eye requiring treatment., Conclusions: Primary SLT achieved comparable early absolute IOP-lowering in OHT versus OAG eyes. Drop-free disease-control was achieved in approximately 75% eyes at 36 months after 1 or 2 SLTs, the majority of these after single SLT. These analyses are exploratory but support primary SLT to be effective and safe in treatment-naive OAG and OHT eyes., (Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.)
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- 2019
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17. Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: the LiGHT RCT.
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Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, Ambler G, Bunce C, Wormald R, Nathwani N, Barton K, Rubin G, Morris S, and Buszewicz M
- Subjects
- Aged, Cost-Benefit Analysis, Female, Humans, Intraocular Pressure drug effects, Male, Quality-Adjusted Life Years, United Kingdom, Visual Acuity physiology, Administration, Ophthalmic, Antihypertensive Agents administration & dosage, Glaucoma diagnosis, Glaucoma therapy, Ocular Hypertension diagnosis, Ocular Hypertension therapy, Trabeculectomy
- Abstract
Background: Newly diagnosed open-angle glaucoma (OAG) and ocular hypertension (OHT) are habitually treated with intraocular pressure (IOP)-lowering eyedrops. Selective laser trabeculoplasty (SLT) is a safe alternative to drops and is rarely used as first-line treatment., Objectives: To compare health-related quality of life (HRQoL) in newly diagnosed, treatment-naive patients with OAG or OHT, treated with two treatment pathways: topical IOP-lowering medication from the outset (Medicine-1st) or primary SLT followed by topical medications as required (Laser-1st). We also compared the clinical effectiveness and cost-effectiveness of the two pathways., Design: A 36-month pragmatic, unmasked, multicentre randomised controlled trial., Settings: Six collaborating specialist glaucoma clinics across the UK., Participants: Newly diagnosed patients with OAG or OHT in one or both eyes who were aged ≥ 18 years and able to provide informed consent and read and understand English. Patients needed to qualify for treatment, be able to perform a reliable visual field (VF) test and have visual acuity of at least 6 out of 36 in the study eye. Patients with VF loss mean deviation worse than -12 dB in the better eye or -15 dB in the worse eye were excluded. Patients were also excluded if they had congenital, early childhood or secondary glaucoma or ocular comorbidities; if they had any previous ocular surgery except phacoemulsification, at least 1 year prior to recruitment or any active treatment for ophthalmic conditions; if they were pregnant; or if they were unable to use topical medical therapy or had contraindications to SLT., Interventions: SLT according to a predefined protocol compared with IOP-lowering eyedrops, as per national guidelines., Main Outcome Measures: The primary outcome was HRQoL at 3 years [as measured using the EuroQol-5 Dimensions, five-level version (EQ-5D-5L) questionnaire]. Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness and safety., Results: Of the 718 patients enrolled, 356 were randomised to Laser-1st (initial SLT followed by routine medical treatment) and 362 to Medicine-1st (routine medical treatment only). A total of 652 (91%) patients returned the primary outcome questionnaire at 36 months. The EQ-5D-5L score was not significantly different between the two arms [adjusted mean difference (Laser-1st - Medicine-1st) 0.01, 95% confidence interval (CI) -0.01 to 0.03; p = 0.23] at 36 months. Over 36 months, the proportion of visits at which IOP was within the target range was higher in the Laser-1st arm (93.0%, 95% CI 91.9% to 94.0%) than in the Medicine-1st arm (91.3%, 95% CI 89.9% to 92.5%), with IOP-lowering glaucoma surgery required in 0 and 11 patients, respectively. There was a 97% probability of Laser-1st being more cost-effective than Medicine-1st for the NHS, at a willingness to pay for a quality-adjusted life-year of £20,000, with a reduction in ophthalmology costs of £458 per patient (95% of bootstrap iterations between -£585 and -£345)., Limitation: An unmasked design, although a limitation, was essential to capture any treatment effects on patients' perception. The EQ-5D-5L questionnaire is a generic tool used in multiple settings and may not have been the most sensitive tool to investigate HRQoL., Conclusions: Compared with medication, SLT provided a stable, drop-free IOP control to 74.2% of patients for at least 3 years, with a reduced need for surgery, lower cost and comparable HRQoL. Based on the evidence, SLT seems to be the most cost-effective first-line treatment option for OAG and OHT, also providing better clinical outcomes., Future Work: Longitudinal research into the clinical efficacy of SLT as a first-line treatment will specify the long-term differences of disease progression, treatment intensity and ocular surgery rates between the two pathways., Trial Registration: Current Controlled Trials ISRCTN32038223., Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 23, No. 31. See the NIHR Journals Library website for further project information., Competing Interests: Gus Gazzard, David Garway-Heath, Rachael Hunter, Gareth Ambler, Catey Bunce, Richard Wormald, Keith Barton, Gary Rubin and Marta Buszewicz have received a grant from the National Institute for Health Research (NIHR) for the submitted work. Gus Gazzard reports grants from Lumenis (Borehamwood, UK) during the conduct of the study; grants from Ellex Medical Lasers (Adelaide, SA, Australia), Ivantis, Inc. (Irvine, CA, USA) and Thea Pharmaceuticals (Keele, UK) outside the submitted work; and personal fees from Allergan (Dublin, Ireland), Alcon (Fort Worth, TX, USA), Glaukos Corporation (San Clemente, CA, USA), Santen Pharmaceutical Co., Ltd (Osaka, Japan) and Thea Pharmaceuticals outside the submitted work. David Garway-Heath reports personal fees from Aerie Pharmaceuticals, Inc. (Durham, NC, USA), Alcon, Allergan, Bausch + Lomb (Rochester, NY, USA), Quark Pharmaceuticals, Inc. (Ness Ziona, Israel), Quethera Limited and Roche (Basel, Switzerland); grants from the Alcon Research Institute; and grants and personal fees from Pfizer (New York, NY, USA) and Santen Pharmaceutical Co., Ltd, outside the submitted work. In addition, David Garway-Heath was a member of the Health Technology Assessment (HTA) Clinical Trials Board from 2014 to 2017. Keith Barton received a grant from NIHR for the Treatment of Advanced Glaucoma Study during the conduct of the study. In addition, Keith Barton reports grants from Johnson & Johnson Vision (Santa Ana, CA, USA), New World Medical (Rancho Cucamonga, CA, USA), Alcon, Merck & Co. (Kenilworth, NJ, USA), Allergan and Refocus Group (Dallas, TX, USA); that he has had other financial relationships with Alcon, Merck & Co., Allergan, Refocus, AqueSys Inc. (Taipei, Taiwan), Ivantis, Carl Zeiss Meditec AG (Jena, Germany), Kowa Europe GmbH (Düsseldorf, Germany), Santen Pharmaceutical Co., Ltd, Transcend Medical (Scottsboro, AL, USA), Glaukos (San Clemente, CA, USA), Amakem NV (Diepenbeek, Belgium), Thea Pharmaceuticals, Alimera Sciences (Alpharette, GA, USA), Pfizer, Advanced Ophthalmic Implants Pte Ltd (Singapore), Vision Futures (UK) Ltd (London, UK), London Claremont Clinic Ltd (London, UK) and Vision Medical Events Ltd (London, UK), outside the submitted work; and that he has a patent with Ophthalmic Implants (PTE) Ltd. Stephen Morris was a member of NIHR Health Services and Delivery Research (HSDR) Research Funding Board (2014–19), the NIHR HSDR Commissioned Board (2014–16), the NIHR HSDR Evidence Synthesis Sub Board (2016), the NIHR HTA Clinical Evaluation and Trials Board (2007–10), the NIHR HTA Commissioning Board (2009–13), the NIHR Public Health Research Funding Board (2011–17) and the NIHR Programme Grants for Applied Research expert subpanel (2017–present). Marta Buszewicz was a member of the HTA Mental Health Panel from January to May 2018. In September 2018 this panel was amalgamated into the HTA Prioritisation Committee C (mental health, women and children’s health), of which Marta Buszewicz was also a member. Marta Buszewicz has also been a member of the NIHR Research for Patient Benefit, London, funding panel since May 2017.
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- 2019
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18. Analysis of a Systematic Review About Blue Light-Filtering Intraocular Lenses for Retinal Protection: Understanding the Limitations of the Evidence.
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Downie LE, Wormald R, Evans J, Virgili G, Keller PR, Lawrenson JG, and Li T
- Subjects
- Cataract Extraction, Humans, Lens Implantation, Intraocular, Prospective Studies, Filtration instrumentation, Lenses, Intraocular, Light, Radiation Injuries prevention & control, Radiation Protection instrumentation, Retina radiation effects
- Abstract
Importance: Cataract surgery, with intraocular lens (IOL) implantation, is the most common ocular surgical procedure worldwide. It has been suggested that IOLs that selectively attenuate short wavelength visible light (blue light-filtering IOLs) may be beneficial for macular health. Whether blue light-filtering IOLs impart retinal photoprotection is of public health relevance, particularly in the context of aging demographics and the increasing global prevalence of age-related macular degeneration. This review analyzes and interprets the key findings, including consideration of the implications for practice and future research, of a 2018 Cochrane systematic review that evaluated the efficacy and safety of blue light-filtering IOLs for providing protection to macular health and function., Observations: The Cochrane systematic review included 51 randomized controlled trials that were performed in 17 countries. The trials involved adults undergoing cataract surgery in which a blue light-filtering IOL was compared with an equivalent non-blue light-filtering IOL. Study follow-up periods ranged from 1 month to 5 years. Together, these studies considered clinical outcomes in more than 5000 eyes. There was limited ability to combine data across trials (to draw overall conclusions) because of the use of different measurement techniques for outcomes, incomplete reporting of data, and/or varied follow-up periods. We identified substantial shortcomings in the internal validity of many of the included studies, particularly regarding trial design, conduct, and reporting. We propose several avenues for improving the rigor of potential future research in the field, including developing a core set of outcome measures, the inclusion of sample size calculations, the masking of trial participants and outcome assessors, and prospective clinical trial registration., Conclusions and Relevance: Using blue light-filtering IOLs to impart benefits to the macula is currently not supported by the best available clinical research evidence, and it is important that clinicians are mindful of this evidence limitation when adopting these devices in clinical practice.
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- 2019
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19. Cochrane Eyes and Vision: a perspective introducing Cochrane Corner in Eye.
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Evans J, Li T, Virgili G, and Wormald R
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- Humans, Blindness prevention & control, Ophthalmology organization & administration, Periodicals as Topic, Randomized Controlled Trials as Topic standards, Systematic Reviews as Topic
- Abstract
In 1972, Archie Cochrane wrote "It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials". The Cochrane Collaboration arose in response to Archie Cochrane's challenge. Cochrane Eyes and Vision aims to prepare and promote access to systematic reviews of interventions for preventing or treating eye conditions and/or visual impairment, and helping people adjust to visual impairment or blindness. To identify all relevant randomised controlled trials, Cochrane Eyes and Vision has a team of information specialists who develop search strategies to identify studies for inclusion in Cochrane reviews. Since 1997 we have published 266 protocols, 193 new reviews and 158 updated reviews. The majority of these are reviews of intervention effectiveness; three reviews are diagnostic test accuracy reviews. Overall 18% of reviews contain no trials, highlighting a potential evidence gap. We provide training, education and guidance to systematic review authors and work with clinical and patient partners to prioritise and disseminate reviews. In addition, Cochrane Eyes and Vision US satellite carries out critical methodologic research addressing topics relevant to producing high-quality reviews. We are partnering with the journal Eye to publish commentaries on selected Cochrane systematic review findings. This partnership will allow us to make high-quality evidence available to ophthalmologists and other practitioners, researchers, policy makers and patients.
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- 2019
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20. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial.
- Author
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Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, Ambler G, Bunce C, Wormald R, Nathwani N, Barton K, Rubin G, and Buszewicz M
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Quality of Life, Treatment Outcome, Antihypertensive Agents administration & dosage, Glaucoma, Open-Angle therapy, Laser Therapy, Ocular Hypertension therapy, Ophthalmic Solutions, Trabeculectomy methods
- Abstract
Background: Primary open angle glaucoma and ocular hypertension are habitually treated with eye drops that lower intraocular pressure. Selective laser trabeculoplasty is a safe alternative but is rarely used as first-line treatment. We compared the two., Methods: In this observer-masked, randomised controlled trial treatment-naive patients with open angle glaucoma or ocular hypertension and no ocular comorbidities were recruited between 2012 and 2014 at six UK hospitals. They were randomly allocated (web-based randomisation) to initial selective laser trabeculoplasty or to eye drops. An objective target intraocular pressure was set according to glaucoma severity. The primary outcome was health-related quality of life (HRQoL) at 3 years (assessed by EQ-5D). Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness, and safety. Analysis was by intention to treat. This study is registered at controlled-trials.com (ISRCTN32038223)., Findings: Of 718 patients enrolled, 356 were randomised to the selective laser trabeculoplasty and 362 to the eye drops group. 652 (91%) returned the primary outcome questionnaire at 36 months. Average EQ-5D score was 0·89 (SD 0·18) in the selective laser trabeculoplasty group versus 0·90 (SD 0·16) in the eye drops group, with no significant difference (difference 0·01, 95% CI -0·01 to 0·03; p=0·23). At 36 months, 74·2% (95% CI 69·3-78·6) of patients in the selective laser trabeculoplasty group required no drops to maintain intraocular pressure at target. Eyes of patients in the selective laser trabeculoplasty group were within target intracoluar pressure at more visits (93·0%) than in the eye drops group (91·3%), with glaucoma surgery to lower intraocular pressure required in none versus 11 patients. Over 36 months, from an ophthalmology cost perspective, there was a 97% probability of selective laser trabeculoplasty as first treatment being more cost-effective than eye drops first at a willingness to pay of £20 000 per quality-adjusted life-year gained., Interpretation: Selective laser trabeculoplasty should be offered as a first-line treatment for open angle glaucoma and ocular hypertension, supporting a change in clinical practice., Funding: National Institute for Health Research, Health and Technology Assessment Programme., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
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- 2019
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21. Improvement in lung function following medialisation thyroplasty in a postbilateral lung transplant patient.
- Author
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Hendriks T and Wormald R
- Subjects
- Hoarseness etiology, Humans, Male, Middle Aged, Phonation physiology, Postoperative Complications surgery, Vocal Cord Paralysis etiology, Laryngoplasty methods, Lung physiopathology, Lung Transplantation adverse effects, Spirometry methods, Vocal Cord Paralysis surgery
- Abstract
A 59-year-old man underwent external medialisation thyroplasty for his left unilateral vocal cord paralysis (UVCP) secondary to recent thoracic surgery. The patient had undergone bilateral lung transplant for idiopathic pulmonary fibrosis and was referred to the ear, nose and throat surgical team with new-onset voice hoarseness. Examination confirmed left UVCP, and after failing conservative management a decision was made to perform external medialisation thyroplasty. Following an uneventful procedure, the patient's phonation returned to normal, and remarkably on spirometry there was evidence of significant improvement in lung function. Despite case series demonstrating subjective improvement in respiration, this is the first documented case, to our knowledge, of significant improvement in spirometry following this procedure., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2018
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22. Laser in Glaucoma and Ocular Hypertension (LiGHT) trial. A multicentre, randomised controlled trial: design and methodology.
- Author
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Gazzard G, Konstantakopoulou E, Garway-Heath D, Barton K, Wormald R, Morris S, Hunter R, Rubin G, Buszewicz M, Ambler G, and Bunce C
- Subjects
- Aged, Antihypertensive Agents therapeutic use, Female, Glaucoma, Open-Angle drug therapy, Humans, Intraocular Pressure physiology, Laser Therapy economics, Male, Middle Aged, Ocular Hypertension drug therapy, Prospective Studies, Quality of Life, Trabeculectomy economics, Treatment Outcome, Visual Acuity physiology, Glaucoma, Open-Angle surgery, Laser Therapy methods, Ocular Hypertension surgery, Research Design, Trabeculectomy methods
- Abstract
Purpose: The Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial aims to establish whether initial treatment with selective laser trabeculoplasty (SLT) is superior to initial treatment with topical medication for primary open-angle glaucoma (POAG) or ocular hypertension (OHT)., Design: The LiGHT Trial is a prospective, unmasked, multicentre, pragmatic, randomised controlled trial. 718 previously untreated patients with POAG or OHT were recruited at six collaborating centres in the UK between 2012 and 2014. The trial comprises two treatment arms: initial SLT followed by conventional medical therapy as required, and medical therapy without laser therapy. Randomisation was provided online by a web-based randomisation service. Participants will be monitored for 3 years, according to routine clinical practice. The target intraocular pressure (IOP) was set at baseline according to an algorithm, based on disease severity and lifetime risk of loss of vision at recruitment, and subsequently adjusted on the basis of IOP control, optic disc and visual field. The primary outcome measure is health-related quality of life (HRQL) (EQ-5D five-level). Secondary outcomes are treatment pathway cost and cost-effectiveness, Glaucoma Utility Index, Glaucoma Symptom Scale, Glaucoma Quality of Life, objective measures of pathway effectiveness, visual function and safety profiles and concordance. A single main analysis will be performed at the end of the trial on an intention-to-treat basis., Conclusions: The LiGHT Trial is a multicentre, pragmatic, randomised clinical trial that will provide valuable data on the relative HRQL, clinical effectiveness and cost-effectiveness of SLT and topical IOP-lowering medication., Trial Registration Number: ISRCTN32038223, Pre-results., Competing Interests: Competing interests: GG, DG-H, KB, RW, SM, RH, GR, MB, GA and CB have received a grant from the National Institute for Health Research for the submitted work. DG-H and RW have received financial support through the Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology. GG received a research grant from Lumenis prior to the submitted work. GG, DG-H and KB have conflicts of interest outside the submitted work., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
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- 2018
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23. Prevalence and Causes of Visual Loss Among the Indigenous Peoples of the World: A Systematic Review.
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Foreman J, Keel S, van Wijngaarden P, Bourne RA, Wormald R, Crowston J, Taylor HR, and Dirani M
- Subjects
- Cross-Sectional Studies, Databases, Factual, Global Health, Health Surveys, Humans, Prevalence, Racial Groups, Risk Factors, Visual Acuity, Blindness epidemiology, Population Groups statistics & numerical data, Vision, Low epidemiology, Visually Impaired Persons statistics & numerical data
- Abstract
Importance: Studies have documented a higher disease burden in indigenous compared with nonindigenous populations, but no global data on the epidemiology of visual loss in indigenous peoples are available. A systematic review of literature on visual loss in the world's indigenous populations could identify major gaps and inform interventions to reduce their burden of visual loss., Objective: To conduct a systematic review on the prevalence and causes of visual loss among the world's indigenous populations., Evidence Review: A search of databases and alternative sources identified literature on the prevalence and causes of visual loss (visual impairment and blindness) and eye diseases in indigenous populations. Studies from January 1, 1990, through August 1, 2017, that included clinical eye examinations of indigenous participants and, where possible, compared findings with those of nonindigenous populations were included. Methodologic quality of studies was evaluated to reveal gaps in the literature., Findings: Limited data were available worldwide. A total of 85 articles described 64 unique studies from 24 countries that examined 79 598 unique indigenous participants. Nineteen studies reported comparator data on 42 085 nonindigenous individuals. The prevalence of visual loss was reported in 13 countries, with visual impairment ranging from 0.6% in indigenous Australian children to 48.5% in native Tibetans 50 years or older. Uncorrected refractive error was the main cause of visual impairment (21.0%-65.1%) in 5 of 6 studies that measured presenting visual acuity. Cataract was the main cause of visual impairment in all 6 studies measuring best-corrected acuity (25.4%-72.2%). Cataract was the leading cause of blindness in 13 studies (32.0%-79.2%), followed by uncorrected refractive error in 2 studies (33.0% and 35.8%)., Conclusions and Relevance: Most countries with indigenous peoples do not have data on the burden of visual loss in these populations. Although existing studies vary in methodologic quality and reliability, they suggest that most visual loss in indigenous populations is avoidable. Improvements in quality and frequency of research into the eye health of indigenous communities appear to be required, and coordinated eye care programs should be implemented to specifically target the indigenous peoples of the world.
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- 2018
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24. Vision loss in Indigenous peoples of the world: a systematic review protocol.
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Foreman J, Keel S, van Wijngaarden P, Bourne R, Wormald R, Crowston J, Taylor HR, and Dirani M
- Subjects
- Cost of Illness, Global Health ethnology, Humans, Prevalence, Research Design, Risk Factors, Systematic Reviews as Topic, Vision Disorders ethnology, Vision Disorders etiology, Global Health statistics & numerical data, Population Groups statistics & numerical data, Vision Disorders epidemiology
- Abstract
Review Objective/question: The objectives of this review are.
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- 2018
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25. What Makes Systematic Reviews Systematic and Why are They the Highest Level of Evidence?
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Wormald R and Evans J
- Subjects
- Humans, Biomedical Research methods, Ophthalmology, Registries, Systematic Reviews as Topic
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- 2018
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26. Risk of Intraocular Bleeding and the New Anticoagulants: Not Such a Big Effect.
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Wormald R and Evans J
- Subjects
- Dabigatran, Eye Hemorrhage, Humans, Anticoagulants, Warfarin
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- 2017
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27. Sight Impairment registration due to stroke-A small yet significant rise?
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Bunce C, Zekite A, Wormald R, and Rowe F
- Subjects
- Disability Evaluation, England epidemiology, Female, Humans, Incidence, Male, Registries, Sex Distribution, Stroke epidemiology, Vision Disorders etiology, Wales epidemiology, Stroke complications, Vision Disorders epidemiology
- Abstract
Objectives: In the United Kingdom, when an individual's sight falls to and remains at a certain threshold, they may be offered registration as sight impaired. Recent analysis of causes of registrable sight impairment in England/Wales indicated that visual impairment due to stroke had increased as a proportionate cause of sight loss. We aim to assess whether there is evidence of an increase in incidence of certification for sight impairment due to stroke in England/Wales between 2008 and 2014., Materials and Methods: The number of certifications with a main cause of sight impairment being stroke was obtained from the Certifications Office London. Directly standardized rates per 100,000 were computed with 95% confidence intervals and examined. Poisson regression was used to assess evidence of trend over time., Results: In the year ending 31st March 2008, 992 people were newly certified with stroke with an estimated DSR of 2.1 (2.0 to 2.2) per 100,000 persons at risk. In the year ending March 31st 2014, there were 1310 certifications with a DSR of 2.5 (2.4 to 2.7). Figures were higher for men than women. Poisson regression indicated an estimated incidence rate ratio of 1.03 per year with 95% confidence intervals of 1.028 to 1.051, P < .001., Conclusions: These data suggest a small but statistically significant increase in the incidence of certifiable visual impairment due to stroke between 2008 and 2014. Figures are, however, considerably lower than estimated, perhaps suggesting that more should be done to address the visual needs of those who have suffered stroke.
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- 2017
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28. Missed opportunity from randomised controlled trials of medical interventions for open-angle glaucoma.
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Law A, Lindsley K, Rouse B, Wormald R, Dickersin K, and Li T
- Subjects
- Antihypertensive Agents therapeutic use, Humans, Meta-Analysis as Topic, Randomized Controlled Trials as Topic methods, Trabeculectomy, Glaucoma, Open-Angle therapy, Intraocular Pressure, Outcome Assessment, Health Care methods, Randomized Controlled Trials as Topic standards, Visual Fields
- Abstract
Purpose: To evaluate the extent to which intraocular pressure and visual field have been reported as outcomes in randomised controlled trials (also referred to as 'trials') of medical treatments for open-angle glaucoma., Methods: We identified published reports of trials in a systematic review of medical interventions for open-angle glaucoma our group conducted. We assessed whether intraocular pressure and visual field were reported as trial outcomes and classified them to be either completely or incompletely reported for meta-analysis. We also collected data on the length of time patients were followed and source of funding for the trial., Results: As of March 2014, we identified 401 trials that had enrolled 76 861 participants. Eighty per cent of 401 trials provided complete information on intraocular pressure and 11% of the 401 trials provided complete information on visual field. Only a minority of trials followed patients for at least 1 year. About half of all reports in our study stated that receiving funding from the industry., Conclusions: Although the vast majority of trials provided sufficient data for meta-analysis of the effect of medical management of open-angle glaucoma on intraocular pressure, relatively few provided data for analysing the effect on visual field. We considered this as missed opportunity because the data were not available for evidence synthesis. Investigators have an obligation to patients and providers to determine the comparative effectiveness of glaucoma interventions in terms of patient-important outcomes and not to waste data that could have been collected in trials., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
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- 2017
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29. Is there evidence that the yearly numbers of children newly certified with sight impairment in England and Wales has increased between 1999/2000 and 2014/2015? A cross-sectional study.
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Bunce C, Zekite A, Wormald R, and Bowman R
- Subjects
- Adolescent, Certification, Child, Child, Preschool, Cross-Sectional Studies, England epidemiology, Female, Humans, Incidence, Infant, Male, Wales epidemiology, Disability Evaluation, Hospitals, Ophthalmology trends, Pediatrics trends, Registries, Vision Disorders epidemiology
- Abstract
Objectives: To use routine data capture from hospitals in England and Wales to identify whether there has been an increase in the annual numbers of children newly certified sight impaired in England and Wales between 1999/2000 and 2014/2015 and to examine causes of certifiable sight impairment in children certified in 2014/2015., Design: A cross-sectional study including an analysis of all certificates of vision impairment completed in hospitals in England and Wales each year between 2007/2008 and 2014/2015 and all certificates completed in hospitals in England and Wales in 1999/2000., Participants: Certificates for all individuals aged 16 years or less at the time of certification in England and Wales for each financial year between 1 April 2007 and the 31 March 2015 and for individuals aged 15 years or less for the year ending 31 March 2000. We obtained information on the main cause of certifiable sight loss for all children certified in 2014/2015. We estimated crude and sex specific incidence estimates with 95% confidence intervals computed by Byars method., Results: In 1999/2000, the estimated incidence (95 % CI) of certification was 8.2 (7.7 to 8.8) per 1 00 000. In 2007/2008, the estimated incidence was statistically significantly higher at 10.1 (9.5 to 10.7). Since then a trend of increasing incidence with time has been observed until 2014/2015 when an estimated incidence of 13.3 (12.6 to 14.0) was observed. Hereditary retinal dystrophies, cerebral visual impairment and nystagmus were the most common single causes of certifiable sight impairment in children in 2014/2015., Conclusion: Our findings show that in England and Wales there has been an increase in the number of children newly certified sight impaired by consultant ophthalmologists since 1999/2000. This mirrors our previous findings based on data originating within social service departments., Competing Interests: Competing interests: The data provided by Moorfields Eye Hospital, captured by the Certificate of Vision impairment (CVI) are Department of Health copyright and this work was made possible by collaboration with the Royal College of Ophthalmologists. Any views expressed in the publication are those of the author(s) alone and are not necessarily those of the Department of Health, the NHS or the NIHR., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
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- 2017
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30. Cochrane Risk of Bias : 'Your common man has no conception of the zeal that animates a scientific investigator, the fury of contradiction you can arouse in him'.
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Bunce C, Lawrenson JG, Wormald R, and Virgili G
- Subjects
- Humans, Male, Bias, Research Personnel
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- 2017
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31. A Mixed-Methods Evaluation of a Community-Based Glaucoma Check Service in Hackney, London, UK.
- Author
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Holdsworth E, Datta J, Marks D, Kuper H, Lee H, Leamon S, Lindfield R, Wormald R, Clarke J, Elkarmouty A, and Macdowall W
- Subjects
- Adult, Aged, Feasibility Studies, Female, Glaucoma epidemiology, Humans, Incidence, London epidemiology, Male, Middle Aged, Patient Participation, Prospective Studies, Clinical Audit methods, Glaucoma diagnosis, Patient Satisfaction, Primary Health Care methods, Referral and Consultation, Vision Screening methods
- Abstract
Purpose: To evaluate the uptake, feasibility and acceptability of a general practice-based optometrist-led glaucoma check service. The service targeted people of black Caribbean and black African descent aged 40-65 years, resident in Hackney, London, United Kingdom., Methods: The study used a mixed-method design, including analysis of service data, prospective audit of secondary care referrals patient survey, cost-consequence analysis, and interviews with staff involved in developing and implementing the service., Results: A total of 3040 patients were invited to undergo the free check; 595 (19.6%) booked an appointment and 461 (15.2%) attended. Overall, 31 patients (6.8%) were referred to secondary care, of whom 22 attended and were assessed for glaucoma. Four were diagnosed with glaucoma and eight with suspected glaucoma, i.e. 2.6% of patients who underwent the check. The cost per patient identified with suspected or confirmed glaucoma was £9,013. Staff who were interviewed suggested that patients who attended might be those who routinely attended optometrist appointments, however only 62.4% of survey respondents reported having had an eye examination in the previous two years, and 11.4% of women and 16.0% of men reported never having had an eye examination., Conclusion: This study represents one possible configuration for a glaucoma case-finding service, and it contributes to a wider debate about whether screening, targeted or otherwise, should be offered in the UK. Our findings suggest that general practice is an acceptable setting and that such a service may reach some people not previously engaged with primary eye care services.
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- 2017
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32. Improving services for glaucoma care in Nigeria: implications for policy and programmes to achieve universal health coverage.
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Kyari F, Gilbert C, Blanchet K, and Wormald R
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- Blindness prevention & control, Delivery of Health Care standards, Health Services Accessibility organization & administration, Health Services Needs and Demand, Humans, Nigeria, Optometry standards, Delivery of Health Care organization & administration, Glaucoma diagnosis, Glaucoma therapy, Optometry organization & administration, Universal Health Insurance organization & administration
- Abstract
Glaucoma in Africa is sometimes referred to as the silent thief of sight. In Nigeria, glaucoma is common, it is serious, ophthalmologists face many constraints in managing it, people do not even know they have it until it is advanced, patients do not understand or comply with treatment after they are diagnosed and the poor are more likely to be glaucoma blind. Available evidence indicates that the health system in Nigeria is failing to meet the needs of patients with glaucoma. Based on evidence, we propose future directions for improving services for glaucoma care in Nigeria, and the implications for policy and programmes to control glaucoma blindness, using a health system-oriented approach. Three complementary strategies are required: (i) strengthening clinical services for glaucoma-by developing models of glaucoma care, improving clinical treatment options, making medicines and equipment available, financing glaucoma care and training eye care workers; (ii) introducing initiatives for earlier detection of glaucoma in the clinic and approaches in the community and (iii) strengthening health system governance. Glaucoma is a complex disease to manage and addressing it as a public health problem is challenging. However, we need to change the paradigm to recognise that glaucoma is a potentially avoidable cause of blindness in Africa., Competing Interests: Competing interestsNone declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
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- 2017
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33. Reply.
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Li T, Lindsley K, Rouse B, Hong H, Shi Q, Friedman DS, Wormald R, and Dickersin K
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- 2016
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34. Uveitis certifications.
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Quartilho A, Simkiss P, Zekite A, Xing W, Wormald R, and Bunce C
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- 2016
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35. Prophylactic non-steroidal anti-inflammatory drugs for the prevention of macular oedema after cataract surgery.
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Lim BX, Lim CH, Lim DK, Evans JR, Bunce C, and Wormald R
- Subjects
- Administration, Topical, Aged, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Humans, Macular Edema etiology, Randomized Controlled Trials as Topic, Steroids therapeutic use, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Cataract Extraction adverse effects, Macular Edema prevention & control, Postoperative Complications prevention & control
- Abstract
Background: Macular oedema (MO) is the accumulation of extracellular fluid in the central retina (the macula). It may occur after cataract surgery and may give rise to poor visual outcome, with reduced visual acuity and distortion of the central vision. MO is often self-limiting with spontaneous resolution, but a small proportion of people with chronic persistent MO may be difficult to treat. Chronic oedema may lead to the formation of cystic spaces in the retina termed 'cystoid macular oedema' (CMO). Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in cataract surgery and may reduce the chances of developing MO., Objectives: The aim of this review is to answer the question: is there evidence to support the prophylactic use of topical NSAIDs either in addition to, or instead of, topical steroids postoperatively to reduce the incidence of macular oedema (MO) and associated visual morbidity., Search Methods: We searched a number of electronic databases including CENTRAL, MEDLINE and Embase. Date last searched 2 September 2016., Selection Criteria: We included randomised controlled trials (RCTs) in which adult participants had undergone surgery for age-related cataract. We included participants irrespective of their baseline risk of MO, in particular we included people with diabetes and uveitis. We included trials of preoperative and/or postoperative topical NSAIDs in conjunction with postoperative topical steroids. The comparator was postoperative topical steroids alone. A secondary comparison was preoperative and/or postoperative topical NSAIDs alone versus postoperative topical steroids alone., Data Collection and Analysis: Two review authors independently selected studies for inclusion, assessed risk of bias and extracted data using standard methods expected by Cochrane. We pooled data using a random-effects model. We graded the certainty of the evidence using GRADE and considered the following: risk of bias of included studies, precision of the effect estimate, consistency of effects between studies, directness of the outcome measure and publication bias., Main Results: We identified 34 studies that were conducted in the Americas, Europe, the Eastern Mediterranean region and South-East Asia. Over 5000 people were randomised in these trials. The majority of studies enrolled one eye per participant; a small subset (4 trials) enrolled a proportion of people with bilateral surgery. Twenty-eight studies compared NSAIDs plus steroids with steroids alone. Six studies compared NSAIDs with steroids. A variety of NSAIDs were used, including ketorolac, diclofenac, nepafenac, indomethacin, bromfenac, flurbiprofen and pranopfen. Follow-up ranged from one to 12 months. In general, the studies were poorly reported. We did not judge any of the studies at low risk of bias in all domains. Six studies were funded by industry, seven studies were funded from non-industry sources, and the rest of the studies did not report the source of funding.There was low-certainty evidence that people receiving topical NSAIDs in combination with steroids may have a lower risk of poor vision due to MO at three months after cataract surgery compared with people receiving steroids alone (risk ratio (RR) 0.41, 95% confidence interval (CI) 0.23 to 0.76; eyes = 1360; studies = 5; I
2 = 5%). We judged this to be low-certainty evidence because of risk of bias in the included studies and indirectness, as the extent of visual loss was not always clear. Only one study reported poor vision due to MO at 12 months and we judged this to be very low-certainty evidence as there were only two events. Quality of life was only reported in one of the 34 studies comparing NSAIDs plus steroids versus steroids alone, and it was not fully reported, other than to comment on lack of differences between groups. There was evidence of a reduced risk of MO with NSAIDs at three months after surgery, but we judged this to be low-certainty due to risk of bias and publication bias (RR 0.40, 95% CI 0.32 to 0.49; eyes = 3638; studies = 21). There was inconsistent evidence on central retinal thickness at three months (I2 = 87%). Results ranged from -30.9 µm in favour of NSAIDs plus steroids to 7.44 µm in favour of steroids alone. Similarly, data on best corrected visual acuity (BCVA) were inconsistent, but nine out of 10 trials reporting this outcome found between-group differences in visual acuity of less than 0.1 logMAR.None of the six studies comparing NSAIDs alone with steroids reported on poor vision due to MO at three or 12 months. There was low-certainty evidence that central retinal thickness was lower in the NSAIDs group at three months (mean difference (MD) -22.64 µm, 95% CI -38.86 to -6.43; eyes = 121; studies = 2). Five studies reported on MO and showed a reduced risk with NSAIDs, but we judged this evidence to be of low-certainty (RR 0.27, 95% CI 0.18 to 0.41; eyes = 520). Three studies reported BCVA at three months and the results of these trials were inconsistent, but all three studies found differences of less than 0.1 logMAR between groups.We did not note any major adverse events - the main consistent observation was burning or stinging sensation with the use of NSAIDs., Authors' Conclusions: Using topical NSAIDs may reduce the risk of developing macular oedema after cataract surgery, although it is possible that current estimates as to the size of this reduction are exaggerated. It is unclear the extent to which this reduction has an impact on the visual function and quality of life of patients. There is little evidence to suggest any important effect on vision after surgery. The value of adding topical NSAIDs to steroids, or using them as an alternative to topical steroids, with a view to reducing the risk of poor visual outcome after cataract surgery is therefore uncertain. Future trials should address the remaining clinical uncertainty of whether prophylactic topical NSAIDs are of benefit, particularly with respect to longer-term follow-up (at least to 12 months), and should be large enough to detect reduction in the risk of the outcome of most interest to patients, which is chronic macular oedema leading to visual loss.- Published
- 2016
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36. Ethnicity and Deprivation are Associated With Blindness Among Adults With Primary Glaucoma in Nigeria: Results From the Nigeria National Blindness and Visual Impairment Survey.
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Kyari F, Wormald R, Murthy GV, Evans JR, and Gilbert CE
- Subjects
- Adult, Aged, Blindness epidemiology, Blindness ethnology, Case-Control Studies, Cataract complications, Ethnicity statistics & numerical data, Female, Glaucoma complications, Humans, Hypertension, Intraocular Pressure physiology, Male, Middle Aged, Nigeria epidemiology, Regression Analysis, Risk Factors, Tonometry, Ocular adverse effects, Blindness etiology, Socioeconomic Factors
- Abstract
Purpose: We explored the risk factors for glaucoma blindness among adults aged 40 years and above with primary glaucoma in Nigeria., Participants and Methods: A total of 13,591 participants aged 40 years and above were examined in the Nigeria Blindness Survey; 682 (5.02%; 95 CI, 4.60%-5.47%) had glaucoma by ISGEO's criteria. This was a case-control study (n=890 eyes of 629 persons): glaucoma blind persons were cases and glaucoma not-blind were controls. Education and occupation were used to determine socioeconomic status scores, which were divided into 3 tertiles (affluent, medium, deprived). We assessed sociodemographic, biophysical, and ocular factors by logistic regression analysis for association with glaucoma blindness. Multinomial regression analysis was also performed with nonglaucoma as the reference category., Results: A total of 119/629 (18.9%; 95% CI, 15.9%-22.4%) persons were blind in both eyes; 510 were controls. There was interethnic variation in odds of blindness; age, male sex, socioeconomic status, prior diagnosis of glaucoma, hypertension, intraocular pressure, and lens opacity were associated with glaucoma blindness. Axial length, mean ocular perfusion pressure, and angle-closure glaucoma were associated with blind glaucoma eyes. In multivariate analysis, Igbo ethnicity (OR=2.79; 95% CI, 1.03-7.57) had higher risk as was being male (OR=4.59; 95% CI, 1.73-12.16) and unmarried (OR=2.50; 95% CI, 1.03-6.07). Deprivation (OR=3.57; 95% CI, 1.46-8.72), prior glaucoma diagnosis (OR=5.89; 95% CI, 1.79-19.40), and intraocular pressure (OR=1.07; 95% CI, 1.04-1.09) were also independent risk factors for glaucoma blindness., Conclusion: Approximately 1 in 5 people with primary glaucoma were blind. Male sex, ethnicity and deprivation were strongly associated with blindness. Services for glaucoma need to improve in Nigeria, focusing on poor communities and men.
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- 2016
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37. Ab interno trabecular bypass surgery with Trabectome for open angle glaucoma.
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Hu K, Gazzard G, Bunce C, and Wormald R
- Subjects
- Humans, Randomized Controlled Trials as Topic, Trabeculectomy methods, Glaucoma, Open-Angle surgery, Phacoemulsification, Trabecular Meshwork surgery, Trabeculectomy instrumentation
- Abstract
Background: Glaucoma is the leading cause of irreversible blindness. Minimally invasive surgical techniques, such as ab interno trabecular bypass surgery, have been introduced to prevent glaucoma progressing., Objectives: The main objective was to assess the results at two years of ab interno trabecular bypass surgery with Trabectome for open angle glaucoma in comparison to conventional medical, laser, or surgical treatment in terms of efficacy and safety. A secondary objective was to examine the effects of Trabectome surgery in people who have concomitant phacoemulsification in comparison to those who do not have concomitant phacoemulsification., Search Methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to May 2016), EMBASE (January 1980 to May 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 12 May 2016., Selection Criteria: We included only randomised controlled trials (RCTs) of ab interno trabecular bypass surgery with Trabectome., Data Collection and Analysis: We planned to have two review authors independently extract data from reports of included studies using a data collection form., Main Results: One randomised controlled trial identified from ClinicalTrials.gov, NCT00901108, met the criteria for inclusion. This study has subsequently been terminated. The ClinicalTrials.gov record indicates that the investigators plan to complete 12 months of follow-up and analysis on 19 participants already recruited into the trial., Authors' Conclusions: There is currently no high-quality evidence for the outcomes of ab interno trabecular bypass surgery with Trabectome for open angle glaucoma. Properly designed RCTs are needed to assess the long-term efficacy and safety of this technique.
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- 2016
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38. Risk factors for open-angle glaucoma in Nigeria: results from the Nigeria National Blindness and Visual Impairment Survey.
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Kyari F, Abdull MM, Wormald R, Evans JR, Nolan W, Murthy GV, and Gilbert CE
- Subjects
- Adult, Age Factors, Aged, Aged, 80 and over, Blindness epidemiology, Blood Pressure physiology, Educational Status, Female, Glaucoma, Open-Angle physiopathology, Humans, Hypertension complications, Intraocular Pressure physiology, Male, Middle Aged, Multivariate Analysis, Nigeria epidemiology, Prevalence, Risk Factors, Sex Factors, Socioeconomic Factors, Visual Acuity physiology, Visual Fields physiology, Glaucoma, Open-Angle etiology
- Abstract
Background: The glaucoma-specific blindness prevalence in Nigeria (0.7 %, 95 % CI 0.6-0.9 %) among those aged ≥40 years is one of the highest ever reported. This study determined the risk factors for open-angle glaucoma (OAG) in adults examined in the Nigeria National Blindness and Visual Impairment Survey., Methods: A nationally representative sample of 13,591 people aged ≥40 years in 305 clusters in Nigeria were examined (response rate 90.4 %) between January 2005 to June 2007. Everyone had logMAR visual acuity measurement, Frequency Doubling Technology (FDT) visual field testing, autorefraction, A-scan biometry and optic disc assessment. Full ocular examination (n = 6397), included Goldmann applanation tonometry. Values for defining glaucoma using International Society of Geographical and Epidemiological Ophthalmology criteria were derived from the study population. Disc images were graded by Moorfields Eye Hospital Reading Centre. Socio-demographic factors (age, gender, ethnicity, literacy and place of residence), ocular parameters (intraocular pressure [IOP], axial length and mean ocular perfusion pressure [MOPP]) and systemic parameters (blood pressure, blood glucose and body mass index [BMI]) were assessed for association with OAG., Results: Thirteen thousand eighty-one (96 %) of 13,591 participants had vertical cup:disc ratio measured in at least one eye. 682 eyes of 462 participants were classified as OAG, with 12,738 controls. In univariate analyses the following were associated with OAG: increasing age, male gender, Igbo and Yoruba ethnic groups, illiteracy, longer axial length, higher IOP, lower MOPP, greater severity of hypertension and low BMI (underweight). In multivariate analysis, increasing age (odds ratio [OR] 1.04, 95 % CI 1.03-1.05), higher IOP (OR 1.22, 95 % CI 1.18-1.25) and Igbo ethnicity (OR 1.73, 95 % CI 1.18-2.56) were independent risk factors for OAG., Conclusion: Case detection strategies for OAG should be improved for those aged ≥40 years and for ethnic groups most at risk as a public health intervention.
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- 2016
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39. Geographical variation in glaucoma prescribing trends in England 2008-2012: an observational ecological study.
- Author
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Heng JS, Wormald R, and Khaw PT
- Subjects
- Adult, Aged, Demography, England epidemiology, Ethnicity, Female, Glaucoma, Open-Angle epidemiology, Glaucoma, Open-Angle physiopathology, Humans, Male, Middle Aged, Ocular Hypertension epidemiology, Ocular Hypertension physiopathology, Sex Distribution, Visual Fields, Antihypertensive Agents administration & dosage, Drug Prescriptions statistics & numerical data, Glaucoma, Open-Angle drug therapy, Ocular Hypertension drug therapy, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Objectives: To explore (1) the national trend in population-adjusted prescription rates for glaucoma and ocular hypertension (OHT) in England and (2) any geographical variation in glaucoma/OHT prescribing trends and its association with established risk factors for primary open-angle glaucoma (POAG) at the population level., Design: Observational ecological study., Setting: Primary care in England 2008-2012., Participants: All patients who received 1 or more of the 37 778 660 glaucoma/OHT prescription items between 2008 and 2012., Primary and Secondary Outcome Measure Methods: Glaucoma/OHT prescription statistics for England and its constituent primary care trusts (PCTs) between 2008 and 2012 were divided by annual population estimates to give prescription rates per 100 000 population aged ≥40 years. To examine regional differences, prescription rates and the change in prescription rates between 2008 and 2012 for PCTs were separately entered into multivariable linear regression models with the population proportion aged ≥60 years; the proportion of males; the proportion of West African Diaspora (WAD) ethnicity; PCT funding per capita; Index of Multiple Deprivation 2010 score and its domains., Results: Between 2008 and 2012, glaucoma/OHT prescriptions increased from 28 029 to 31 309 items per 100 000 population aged ≥40 years. Between PCTs, nearly a quarter of the variation in prescription rates in 2008 and 2012 could be attributed to age, WAD ethnicity and male gender. The change in prescription rates between 2008 and 2012 was only modestly correlated with age (p=0.003, β=0.234), and income deprivation (p=0.035, β=-0.168)., Conclusions: Increased population-adjusted glaucoma/OHT prescription rates in the study period were likely due to increased detection of POAG and OHT cases at risk of POAG. Between PCTs, regional variation in overall prescription rates was partly attributable to demographic risk factors for POAG, although the change in prescription rates was only modestly correlated with the same risk factors, suggesting potential variation in practice., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)
- Published
- 2016
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40. Leading causes of certifiable visual loss in England and Wales during the year ending 31 March 2013.
- Author
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Quartilho A, Simkiss P, Zekite A, Xing W, Wormald R, and Bunce C
- Subjects
- Aged, Aged, 80 and over, Blindness etiology, Diabetic Retinopathy complications, Diabetic Retinopathy epidemiology, Disability Evaluation, England epidemiology, Eye Diseases complications, Female, Glaucoma complications, Glaucoma epidemiology, Humans, Macular Degeneration complications, Macular Degeneration epidemiology, Male, Optic Atrophy complications, Optic Atrophy epidemiology, Prevalence, Registries statistics & numerical data, Retinal Diseases complications, Retinal Diseases epidemiology, Vision, Low etiology, Wales epidemiology, Blindness epidemiology, Eye Diseases epidemiology, Vision, Low epidemiology
- Abstract
Purpose: The last article on causes of sight impairment (SI) in England and Wales was for April 2007-March 2008. This report updates these figures for April 2012-March 2013., Methods: In England and Wales, registration for SI is initiated by completion of a certificate of vision impairment (CVI). The main cause of visual impairment was ascertained for certificates completed April 2012-March 2013. A proportional comparison against April 2007-March 2008 was made., Results: We received 24 009 CVIs of which 10 410 were for severe sight impairment (SSI) and 13 129 were for SI. These numbers were slightly higher than those observed in April 2007-March 2008 (9823 SSI; 12 607 SI). The ratio SI:SSI has remained static with 55% of all certifications being SI. The proportion of certificates without a single main cause has fallen slightly (16.6 to 14%). The proportion of certificates with a main cause of degeneration of the macula and posterior pole (mostly age-related macular degeneration (AMD)) decreased from 58.6 to 50% SSI and from 57.2 to 52.5% SI. Glaucoma remains the second most common cause (11% SSI; 7.6% SI) but hereditary retinal disorders overtook diabetes as third leading cause of SSI., Conclusion: AMD is still by far the leading cause of certifications for sight impairment in England and Wales (both SI and SSI). Proportionate changes have been observed since 2008, but it is important to note that a proportionate increase in one condition will impact on others.
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- 2016
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41. The Royal College of Ophthalmologists' Cataract Surgery Commissioning Guidance: executive summary.
- Author
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Day AC, Wormald R, Coronini-Cronberg S, and Smith R
- Subjects
- Cataract epidemiology, Contrast Sensitivity physiology, Critical Pathways, Depth Perception physiology, Humans, Outcome and Process Assessment, Health Care, Pseudophakia physiopathology, Quality of Health Care, Societies, Medical organization & administration, State Medicine, United Kingdom, Vision Disorders physiopathology, Visual Acuity physiology, Cataract Extraction standards, Lens Implantation, Intraocular, Ophthalmology organization & administration, Practice Guidelines as Topic standards, Practice Patterns, Physicians' standards
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- 2016
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42. Potential for a paradigm change in the detection of retinopathy of prematurity requiring treatment.
- Author
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Gilbert C, Wormald R, Fielder A, Deorari A, Zepeda-Romero LC, Quinn G, Vinekar A, Zin A, and Darlow B
- Subjects
- Humans, Infant, Newborn, Infant, Premature, Neonatal Screening economics, Retinopathy of Prematurity economics, Neonatal Screening methods, Retinopathy of Prematurity diagnosis
- Published
- 2016
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43. Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis.
- Author
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Li T, Lindsley K, Rouse B, Hong H, Shi Q, Friedman DS, Wormald R, and Dickersin K
- Subjects
- Glaucoma, Open-Angle physiopathology, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Antihypertensive Agents therapeutic use, Glaucoma, Open-Angle drug therapy, Intraocular Pressure drug effects
- Abstract
Topic: Primary open-angle glaucoma (POAG) is a highly prevalent condition worldwide and the most common cause of irreversible sight loss. The objective is to assess the comparative effectiveness of first-line medical treatments in patients with POAG or ocular hypertension through a systematic review and network meta-analysis, and to provide relative rankings of these treatments., Clinical Relevance: Treatment for POAG currently relies completely on lowering the intraocular pressure (IOP). Although topical drops, lasers, and surgeries can be considered in the initial treatment of glaucoma, most patients elect to start treatment with eye drops., Methods: We included randomized controlled trials (RCTs) that compared a single active topical medication with no treatment/placebo or another single topical medication. We searched CENTRAL, MEDLINE, EMBASE, and the Food and Drug Administration's website. Two individuals independently assessed trial eligibility, abstracted data, and assessed the risk of bias. We performed Bayesian network meta-analyses., Results: We included 114 RCTs with data from 20 275 participants. The overall risk of bias of the included trials is mixed. The mean reductions (95% credible intervals) in IOP in millimeters of mercury at 3 months ordered from the most to least effective drugs were as follows: bimatoprost 5.61 (4.94; 6.29), latanoprost 4.85 (4.24; 5.46), travoprost 4.83 (4.12; 5.54), levobunolol 4.51 (3.85; 5.24), tafluprost 4.37 (2.94; 5.83), timolol 3.70 (3.16; 4.24), brimonidine 3.59 (2.89; 4.29), carteolol 3.44 (2.42; 4.46), levobetaxolol 2.56 (1.52; 3.62), apraclonidine 2.52 (0.94; 4.11), dorzolamide 2.49 (1.85; 3.13), brinzolamide 2.42 (1.62; 3.23), betaxolol 2.24 (1.59; 2.88), and unoprostone 1.91 (1.15; 2.67)., Conclusions: All active first-line drugs are effective compared with placebo in reducing IOP at 3 months. Bimatoprost, latanoprost, and travoprost are among the most efficacious drugs, although the within-class differences were small and may not be clinically meaningful. All factors, including adverse effects, patient preferences, and cost, should be considered in selecting a drug for a given patient., (Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
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- 2016
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44. A Population-based survey of the prevalence and types of glaucoma in Nigeria: results from the Nigeria National Blindness and Visual Impairment Survey.
- Author
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Kyari F, Entekume G, Rabiu M, Spry P, Wormald R, Nolan W, Murthy GV, and Gilbert CE
- Subjects
- Adult, Age Distribution, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Glaucoma, Angle-Closure classification, Glaucoma, Open-Angle classification, Health Surveys, Humans, Intraocular Pressure physiology, Male, Middle Aged, Nigeria epidemiology, Prevalence, Sex Distribution, Visual Acuity physiology, Visual Fields physiology, Blindness epidemiology, Glaucoma, Angle-Closure epidemiology, Glaucoma, Open-Angle epidemiology, Vision, Low epidemiology, Visually Impaired Persons statistics & numerical data
- Abstract
Background: Glaucoma is the leading cause of irreversible blindness worldwide. There tends to be a lower reporting of glaucoma in Africa compared to other blinding conditions in global burden data. Research findings of glaucoma in Nigeria will significantly increase our understanding of glaucoma in Nigeria, in people of the West African diaspora and similar population groups. We determined the prevalence and types of glaucoma in Nigeria from the Nigeria National Blindness and Visual Impairment cross-sectional Survey of adults aged ≥40 years., Methods: Multistage stratified cluster random sampling with probability-proportional-to-size procedures were used to select a nationally representative sample of 15,027 persons aged ≥40 years. Participants had logMAR visual acuity measurement, FDT visual function testing, autorefraction, A-scan biometry and optic disc assessment. Participants with visual acuity of worse than 6/12 or suspicious optic discs had detailed examination including Goldmann applanation tonometry, gonioscopy and fundus photography. Disc images were graded by Moorfields Eye Hospital Reading Centre. Glaucoma was defined using International Society of Geographical and Epidemiological Ophthalmology criteria; and classified into primary open-angle or primary angle-closure or secondary glaucoma. Diagnosis of glaucoma was based on ISGEO classification. The type of glaucoma was determined by gonioscopy., Results: A total of 13,591 participants in 305 clusters were examined (response rate 90.4 %). Optic disc grading was available for 25,289 (93 %) eyes of 13,081 (96 %) participants. There were 682 participants with glaucoma; a prevalence of 5.02 % (95 % CI 4.60-5.47). Among those with definite primary glaucoma that had gonioscopy (n = 243), open-angle glaucoma was more common (86 %) than angle-closure glaucoma (14 %). 8 % of glaucoma was secondary with the commonest causes being couching (38 %), trauma (21 %) and uveitis (19 %). Only 5.6 % (38/682) of participants with glaucoma knew they had the condition. One in every 5 persons with glaucoma (136;20 %) was blind i.e., visual acuity worse than 3/60., Conclusion: Nigeria has a high prevalence of glaucoma which is largely open-angle glaucoma. A high proportion of those affected are blind. Secondary glaucoma was mostly as a consequence of procedures for cataract. Public health control strategies and high quality glaucoma care service will be required to reduce morbidity and blindness from glaucoma.
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- 2015
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45. Certification figures and their accuracy.
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Quartilho A, Zekite A, Xing W, Loutfi M, Bunce C, and Wormald R
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- Female, Humans, Male, Angiogenesis Inhibitors therapeutic use, Antibodies, Monoclonal, Humanized therapeutic use, Blindness epidemiology, Vision, Low epidemiology, Visually Impaired Persons statistics & numerical data, Wet Macular Degeneration drug therapy
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- 2015
- Full Text
- View/download PDF
46. Congenital nasal pyriform aperture stenosis 5.7 mm or less is associated with surgical intervention: A pooled case series.
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Wormald R, Hinton-Bayre A, Bumbak P, and Vijayasekaran S
- Subjects
- Adult, Child, Constriction, Pathologic surgery, Female, Humans, Infant, Newborn, Male, Nasal Obstruction diagnostic imaging, Nasal Obstruction surgery, Retrospective Studies, Sensitivity and Specificity, Nasal Obstruction etiology, Tomography, X-Ray Computed methods
- Abstract
Objectives: Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of upper airway obstruction in the newborn. CNPAS is diagnosed clinically and confirmed with CT scanning. Early diagnosis and management is essential for this potentially life-threatening condition. Patients can be managed conservatively or surgically. Surgical treatment is usually reserved for those patients that fail conservative treatment. Our objective was to provide a radiologically-measured pyriform aperture (PA) width that predicts the need for surgical intervention., Methods: This study was a retrospective chart review of patients treated in a tertiary paediatric hospital as well as a review of the literature. Outcome measures were defined as surgical or conservative intervention for the management of congenital pyriform aperture stenosis., Results: Data from 26 individual patients (7 patients from our own case series and 19 patients from previously published reports) was analysed to calculate those patients requiring surgical intervention., Conclusions: A PA width of less than 5.7 mm in a neonate is 88% sensitive and specific in predicting that a patient will require surgical intervention., (Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.)
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- 2015
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47. Considerations for randomizing 1 eye or 2 eyes.
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Bunce C and Wormald R
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- Humans, Data Interpretation, Statistical, Eye Diseases drug therapy, Ophthalmic Solutions administration & dosage, Ophthalmology statistics & numerical data, Pharmaceutical Preparations administration & dosage, Randomized Controlled Trials as Topic statistics & numerical data
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- 2015
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48. Incidence of Late-Stage Age-Related Macular Degeneration in American Whites: Systematic Review and Meta-analysis.
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Rudnicka AR, Kapetanakis VV, Jarrar Z, Wathern AK, Wormald R, Fletcher AE, Cook DG, and Owen CG
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- Age Distribution, Aged, Aged, 80 and over, Female, Humans, Incidence, Male, Middle Aged, Prospective Studies, Sex Distribution, United States epidemiology, Geographic Atrophy ethnology, Wet Macular Degeneration ethnology, White People
- Abstract
Purpose: To estimate incidence of age-related macular degeneration (AMD) by subtype in American whites aged ≥50 years., Design: Systematic review and meta-analysis., Setting: Prospective cohort studies of AMD incidence in populations of white European ancestry published in MEDLINE, EMBASE, and Web of Science., Study Population: Fourteen publications in 10 populations that examined AMD incident cases were identified., Observation Procedure: Data on age-sex-specific incidence of late AMD, geographic atrophy (GA) and neovascular AMD (NVAMD), year of recruitment, AMD grading method, and continent were extracted., Main Outcome Measure(s): Annual incidence of late AMD, GA, and NVAMD by age-sex in American whites aged ≥50 years from a Bayesian meta-analysis of incidence studies was compared with incidence extrapolated from published prevalence estimates., Results: Incidence rates from the review agreed with those derived from prevalence, but the latter were based on more data, especially at older ages and by AMD subtypes. Annual incidence (estimated from prevalence) of late AMD in American whites was 3.5 per 1000 aged ≥50 years (95% credible interval 2.5, 4.7 per 1000), equivalent to 293 000 new cases in American whites per year (95% credible interval 207 000, 400 000). Incidence rates approximately quadrupled per decade in age. Annual incidence GA rates were 1.9 per 1000 aged ≥50 years, NVAMD rates were 1.8 per 1000. Late AMD incidence was 38% higher in women vs men (95% credible interval 6%, 82%)., Conclusions: Estimating AMD incidence from prevalence allows better characterization at older ages and by AMD subtype where longitudinal data from incidence studies are limited., (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2015
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49. Nigeria normative data for defining glaucoma in prevalence surveys.
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Kyari F, Abdull MM, Sallo FB, Spry PG, Wormald R, Peto T, Faal HB, and Gilbert CE
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- Adult, Age Distribution, Blindness epidemiology, Cross-Sectional Studies, Female, Gonioscopy, Health Surveys, Humans, Male, Middle Aged, Nigeria epidemiology, Prevalence, Reference Values, Sex Distribution, Visually Impaired Persons statistics & numerical data, Glaucoma diagnosis, Glaucoma epidemiology, Intraocular Pressure physiology, Optic Disk pathology, Visual Acuity physiology, Visual Fields physiology
- Abstract
Purpose: To determine normative values for defining glaucoma in cross-sectional surveys in Nigerian adults., Methods: Multistage stratified cluster random sampling with probability-proportional-to-size procedures to select a nationally representative sample of 15,027 persons aged ≥ 40 years in 305 clusters across Nigeria. Systematic sampling of 1 in 7 participants gave 1759 who were examined in detail to construct a normative database. The normative subset was used to determine values for vertical cup/disc ratio (VCDR) and intraocular pressure (IOP) for glaucoma diagnosis according to the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. Examinations included visual field testing by frequency doubling technology (FDT), Goldmann applanation tonometry, and optic disc image grading by Moorfields Eye Hospital Reading Centre., Results: In the normative dataset, 1057/1759 persons (60.1%) had normal FDTs, and constituted the hypernormal. Of these, 851 had VCDR and 973 had IOP measurements taken in both eyes. For category 1 (structural and functional evidence of glaucoma), the 97.5th percentile VCDR was 0.7. For category 2 (advanced structural damage with unproven visual field loss), the 99.5th percentile VCDR was 0.75. In addition, asymmetry in VCDR was 0.1 difference at the 97.5th percentile and 0.2 difference at the 99.5th percentile. Category 3 criteria were used when the optic disc was not visible and field testing not possible; 99.5th percentile IOP is one criterion (28 mmHg)., Conclusion: While these results do not differentiate between open-angle and angle-closure mechanisms, they can be applied to determine the prevalence of glaucoma in Nigeria and sub-Saharan African countries with similar sociodemographic characteristics.
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- 2015
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50. Preventing eye injuries in quarries.
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Wormald R and Patel D
- Published
- 2015
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