165 results on '"Sparrow JM"'
Search Results
2. Randomised trial of effectiveness of second eye cataract surgery
- Author
-
Laidlaw, Dah, Harrad, RA, Hopper, CD, Whitaker, A., Donovan, JL, Brookes, ST, Marsh, GW, Peters, TJ, Sparrow, JM, and Frankel, SJ
- Published
- 1998
3. The Cataract National Dataset electronic multi-centre audit of 55,567 operations: risk indicators for monocular visual acuity outcomes.
- Author
-
Sparrow JM, Taylor H, Qureshi K, Smith R, Birnie K, Johnston RL, Sparrow, J M, Taylor, H, Qureshi, K, Smith, R, Birnie, K, Johnston, R L, and UK EPR user group
- Abstract
Aims: To report risk factors for visual acuity (VA) improvement and harm following cataract surgery using electronically collected multi-centre data conforming to the Cataract National Dataset (CND).Methods: Routinely collected anonymised data were remotely extracted from the electronic patient record systems of 12 participating NHS Trusts undertaking cataract surgery. Following data checks and cleaning, analyses were performed to identify risk indicators for: (1) a good acuity outcome (VA 6/12 or better), (2) the pre- to postoperative change in VA, and (3) VA loss (doubling or worse of the visual angle).Results: In all, 406 surgeons from 12 NHS Trusts submitted data on 55,567 cataract operations. Preoperative VA was known for 55,528 (99.9%) and postoperative VA outcome for 40,758 (73.3%) operations. Important adverse preoperative risk indicators found in at least 2 of the 3 analyses included older age (3), short axial length (3), any ocular comorbidity (3), age-related macular degeneration (2), diabetic retinopathy (3), amblyopia (2), corneal pathology (2), previous vitrectomy (2), and posterior capsule rupture (PCR) during surgery (3). PCR was the only potentially modifiable adverse risk indicator and was powerfully associated with VA loss (OR=5.74).Conclusion: Routinely collected electronic data conforming to the CND provide sufficient detail for identification and quantification of preoperative risk indicators for VA outcomes of cataract surgery. The majority of risk indicators are intrinsic to the patient or their eye, with a notable exception being PCR during surgery. [ABSTRACT FROM AUTHOR]- Published
- 2012
- Full Text
- View/download PDF
4. The Cataract National Dataset electronic multi-centre audit of 55,567 operations: variation in posterior capsule rupture rates between surgeons.
- Author
-
Johnston RL, Taylor H, Smith R, Sparrow JM, Johnston, R L, Taylor, H, Smith, R, and Sparrow, J M
- Abstract
Aims: To demonstrate variations in posterior capsule rupture (PCR) rate between surgeons of the same and different grades as a by-product of routine clinical care.Method: NHS departments using electronic medical record (EMR) systems to collect the Cataract National Dataset (CND) were invited to submit data. Data were remotely extracted, anonymised, assessed for conformity and completeness, and analysed for rates of PCR for individual surgeons within each of the three grades.Results: Data were extracted on 55,567 cataract operations performed at 12 NHS trusts by 406 surgeons between November 2001 and July 2006. Data on the grade of 404 of the 406 surgeons who contributed to the study were available for 55,515 cases (99.9%) and were used for this analysis. Variation in PCR rate between surgeons was highest for the most junior grade of surgeon and between those surgeons contributing relatively few cases to the data set. Variation in PCR was lowest among experienced surgeons contributing large numbers of cases to the data set.Conclusions: Considerable variation in PCR rate exists both between and within surgical grades. Routine electronic collection of the CND allows detailed analysis of variations in PCR rates between individual surgeons. To define acceptable limits for this benchmark complication of cataract surgery, further work is needed to adjust surgeons' outcomes for the case mix complexity. [ABSTRACT FROM AUTHOR]- Published
- 2010
- Full Text
- View/download PDF
5. The Cataract National Dataset electronic multicentre audit of 55,567 operations: when should IOLMaster biometric measurements be rechecked?
- Author
-
Knox Cartwright NE, Johnston RL, Jaycock PD, Tole DM, Sparrow JM, Knox Cartwright, N E, Johnston, R L, Jaycock, P D, Tole, D M, and Sparrow, J M
- Abstract
Purpose: Calculation of intraocular lens (IOL) power for implantation during cataract surgery depends on ocular biometric measurements. The aim of this study was to characterise the normal range of intra- and interindividual variation in axial length (AL) and corneal power (K) when IOLMaster measurements were possible and to derive recommendations as to which outlying measurements merit verification before acceptance.Methods: The Medisoft electronic patient database contains prospectively collected data conforming to the United Kingdom (UK) Cataract National Dataset on 55,567 cataract operations. From this AL and K information on the 32,556 eyes (14,016 paired) of patients older than 25 years, without corneal pathology, history of intraocular surgery and who had all biometric measurements taken with the Zeiss IOLMaster (Carl Zeiss Meditec) were extracted. R 2.8.1 (R Foundation for Statistical Computing) was used for statistical analysis.Results: Mean age was 76.4 years and 62.0% were female. Mean (95% confidence interval) values for AL, mean K and corneal astigmatism were 23.40 (21.27-26.59) mm, 43.90 (40.94-47.01) D and 1.04 (<2.50) D. Nearly all astigmatism was either with or against the rule. Differences between paired eyes were not statistically significant. 95% individuals had asymmetry of AL and mean K<0.70 mm and 0.92 D, respectively.Conclusions: On the basis of approximation of the 95% CI above, it is suggested that AL, mean K and keratometric astigmatism measurements outside the ranges 21.30-26.60 mm, 41.00-47.00 D and >2.50 D, respectively, and intraindividual asymmetry of AL >0.70 mm or mean K>0.90 D should be verified before acceptance. [ABSTRACT FROM AUTHOR]- Published
- 2010
- Full Text
- View/download PDF
6. Ocular air gun injuries: a one-year surveillance study in the UK and Eire (BOSU). 2001-2002.
- Author
-
Shuttleworth GN, Galloway P, Sparrow JM, Lane C, Shuttleworth, G N, Galloway, P, Sparrow, J M, and Lane, C
- Abstract
Aims: The vulnerability of the eye means that ocular air gun injuries figure prominently in the medical literature. This Study reports the results of the first ocular air gun injury surveillance study.Methods: Ocular air gun injuries were reported to the British Ophthalmic Surveillance Unit (BOSU; United Kingdom and Eire) for the period November 2001-December 2002 (13 months). Two questionnaires were used to collect demographic details, circumstances of injury, details of injuries, medical management and outcome.Results: A total of 105 initial and 99 follow-up questionnaires were returned. Eighty-six ocular air gun injuries occurred during the last 12 months of surveillance yielding a corrected, estimated incidence of 91-115 injuries/year. Injuries were most frequent in August/September, and 90% (95/105) of victims were men with mean age of 17.5 years (74% under 18 years). In all, 40% (32/81) of injuries occurred at home and 53% (43/81) in a public place. 23% (19/84) of injuries were deliberate, 66% (69/104) of injuries were severe and 20% (21/105) resulted in ruptured globes. In all, 54% (48/89) required hospital admission and 41 required surgery. A total of 11% (12/105) of eyes were either enucleated or eviscerated. Final visual acuity was6/12 (Snellen) in 65% (59/91). Moderate/significant cosmetic deformities were recorded in 10% (8/77) and restricted ocular movements in 5% (4/72). Conclusions: Ocular air gun injuries damage sight and leave lasting morbidity. The demographics and circumstances of injury are well documented with access to, and unsupervised use of, air guns, appearing the principal risks for injury. [ABSTRACT FROM AUTHOR]- Published
- 2009
- Full Text
- View/download PDF
7. The Cataract National Dataset electronic multicentre audit of 55,567 operations: antiplatelet and anticoagulant medications.
- Author
-
Benzimra JD, Johnston RL, Jaycock P, Galloway PH, Lambert G, Chung AK, Eke T, Sparrow JM, and EPR User Group
- Published
- 2009
- Full Text
- View/download PDF
8. The Cataract National Dataset Electronic Multi-centre Audit of 55,567 operations: anaesthetic techniques and complications.
- Author
-
El-Hindy N, Johnston RL, Jaycock P, Eke T, Braga AJ, Tole DM, Galloway P, Sparrow JM, UK EPR user group, El-Hindy, N, Johnston, R L, Jaycock, P, Eke, T, Braga, A J, Tole, D M, Galloway, P, and Sparrow, J M
- Abstract
Purpose: The primary aim of this study was to detail anaesthetic techniques and complications for cataract surgery in the UK.Methods: The Cataract National Dataset was extracted from 12 National Health Service Trusts that used the same electronic patient record system between November 2001 and July 2006 on a total of 55,567 cataract operations.Results: Anaesthesia was administered by an ophthalmologist in 56.7% of the cases, a career anaesthetist in 42.1% of the cases, a clinical assistant anaesthetist in 0.3% of the cases, and staff were not recorded in 0.9% of the cases. Local anaesthesia (LA) was used in 95.5%, with topical anaesthesia alone in 22.3% (range by site, 0-99.8%), topical and intracameral in 4.7% (range, 0-24.1%), subtenons in 46.9% (range, 0-81.8%), peribulbar in 19.5% (range, 0-63.4%), and retrobulbar in 0.5% (range, 0-5.3%). One or more minor complications occurred in 4.3% of 38,058 local blocks administered by either sharp needle or subtenons (blunt) cannula. Minor complications were 2.3 times more common with subtenons blocks (P<0.001). Serious complications, defined as sight or life threatening occurred in 25 eyes, 0.066%, undergoing sharp needle or subtenons cannula blocks. Sharp needle techniques had a 2.5-fold increased risk of serious complications compared with subtenons cannula techniques (P=0.026).Conclusion: Subtenons anaesthesia was the most widely used anaesthetic technique for cataract surgery but wide variation existed by site. There was a low rate of reported LA complications. There was a statistically significant increased risk of serious complications with sharp needle anaesthesia compared with subtenons technique. [ABSTRACT FROM AUTHOR]- Published
- 2009
- Full Text
- View/download PDF
9. The Cataract National Dataset electronic multicentre audit of 55,567 operations: risk stratification for posterior capsule rupture and vitreous loss.
- Author
-
Narendran N, Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM, Asaria RH, Galloway P, and Sparrow JM
- Published
- 2009
- Full Text
- View/download PDF
10. The Cataract National Dataset electronic multi-centre audit of 55,567 operations: updating benchmark standards of care in the United Kingdom and internationally.
- Author
-
Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM, Galloway P, Canning C, Sparrow JM, UK EPR user group, Jaycock, P, Johnston, R L, Taylor, H, Adams, M, Tole, D M, Galloway, P, Canning, C, and Sparrow, J M
- Abstract
Aims: To pilot the use of the Cataract National Dataset (CND) using multi-centre data from Electronic Patient Record (EPR) systems and to demonstrate the ability of the CND to deliver certain of its intended benefits, including detailed preoperative profiling of cataract surgery patients and updating of benchmark standards of care in the NHS and beyond.Methods: NHS departments using EPR systems to collect a minimum preoperative, anaesthetic, operative and postoperative data set, the CND, were invited to submit data, which were remotely extracted, anonymised, assessed for conformity and completeness, and analysed.Results: Four-hundred and six surgeons from 12 NHS Trusts submitted data on 55,567 cataract operations between November 2001 and July 2006 (86% from January 2004). Mean age (SD) was 75.4 (10.4) years, 62.0% female. Surgery was for first eyes in 58.5%, under local anaesthesia in 95.5% and by phacoemulsification in 99.7%. Trainees performed 33.9% of operations. Preoperative visual acuity (VA) was 6/12 or better in 42.9% eyes overall, in 35.3% first eyes and in 55.3% second eyes. Complication rates included the following: posterior capsule rupture and/or vitreous loss of 1.92%, simple zonule dialysis of 0.46% and retained lens fragments of 0.18%. Postoperative VA of 6/12 or better (and 6/6 or better) was achieved for 91.0% (45.9%) of all eyes, 94.7% (51.0%) of eyes with no co-pathologies and 79.9% (30.2%) of eyes with one or more co-pathologies respectively.Conclusions: The CND is fit for purpose, is able to deliver useful benefits and can be collected as part of routine clinical care via EPR systems. This survey confirms shifts in practice since the 1997-1998 UK National Survey with full conversion to phacoemulsification, better preoperative acuity, a halving of the surgical 'index' benchmark complication of posterior capsule rupture and/or vitreous loss, and improved VA outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2009
- Full Text
- View/download PDF
11. The Wisconsin age-related macular degeneration grading system: performance in an independent centre.
- Author
-
Dickinson, M, Duke, AM, and Sparrow, JM
- Published
- 1997
- Full Text
- View/download PDF
12. Evaluating Primary Treatment for People with Advanced Glaucoma: Five-Year Results of the Treatment of Advanced Glaucoma Study.
- Author
-
King AJ, Hudson J, Azuara-Blanco A, Burr J, Kernohan A, Homer T, Shabaninejad H, Sparrow JM, Garway-Heath D, Barton K, Norrie J, Davidson T, Vale L, and MacLennan G
- Subjects
- Humans, Male, Female, Aged, Middle Aged, Surveys and Questionnaires, Follow-Up Studies, Treatment Outcome, Tonometry, Ocular, Sickness Impact Profile, Ophthalmic Solutions, Alkylating Agents administration & dosage, Aged, 80 and over, Trabeculectomy methods, Intraocular Pressure physiology, Quality of Life, Visual Acuity physiology, Antihypertensive Agents therapeutic use, Visual Fields physiology, Glaucoma, Open-Angle physiopathology, Glaucoma, Open-Angle surgery, Glaucoma, Open-Angle drug therapy, Mitomycin administration & dosage
- Abstract
Purpose: To determine whether primary trabeculectomy or medical treatment produces better outcomes in terms of quality of life (QoL), clinical effectiveness, and safety in patients with advanced glaucoma., Design: Multicenter randomized controlled trial., Participants: Between June 3, 2014, and May 31, 2017, 453 adults with newly diagnosed advanced open-angle glaucoma in at least 1 eye (Hodapp classification) were recruited from 27 secondary care glaucoma departments in the United Kingdom. Two hundred twenty-seven were allocated to trabeculectomy, and 226 were allocated medical management., Methods: Participants were randomized on a 1:1 basis to have either mitomycin C-augmented trabeculectomy or escalating medical management with intraocular pressure (IOP)-reducing drops as the primary intervention and were followed up for 5 years., Main Outcome Measures: The primary outcome was vision-specific QoL measured with the 25-item Visual Function Questionnaire (VFQ-25) at 5 years. Secondary outcomes were general health status, glaucoma-related QoL, clinical effectiveness (IOP, visual field, and visual acuity), and safety., Results: At 5 years, the mean ± standard deviation VFQ-25 scores in the trabeculectomy and medication arms were 83.3 ± 15.5 and 81.3 ± 17.5, respectively, and the mean difference was 1.01 (95% confidence interval [CI], -1.99 to 4.00; P = 0.51). The mean IOPs were 12.07 ± 5.18 mmHg and 14.76 ± 4.14 mmHg, respectively, and the mean difference was -2.56 (95% CI, -3.80 to -1.32; P < 0.001). Glaucoma severity measured with visual field mean deviation were -14.30 ± 7.14 dB and -16.74 ± 6.78 dB, respectively, with a mean difference of 1.87 (95% CI, 0.87-2.87 dB; P < 0.001). Safety events occurred in 115 (52.2%) of patients in the trabeculectomy arm and 124 (57.9%) of patients in the medication arm (relative risk, 0.92; 95% CI, 0.72-1.19; P = 0.54). Serious adverse events were rare., Conclusions: At 5 years, the Treatment of Advanced Glaucoma Study demonstrated that primary trabeculectomy surgery is more effective in lowering IOP and preventing disease progression than primary medical treatment in patients with advanced disease and has a similar safety profile., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
13. The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: Report 9, Risk factors for posterior capsule opacification.
- Author
-
Donachie PHJ, Barnes BL, Olaitan M, Sparrow JM, and Buchan JC
- Subjects
- Humans, Female, Lens Implantation, Intraocular adverse effects, Retrospective Studies, Risk Factors, Postoperative Complications etiology, Capsule Opacification epidemiology, Capsule Opacification etiology, Capsule Opacification surgery, Lenses, Intraocular adverse effects, Ophthalmology, Ophthalmologists, Lens Capsule, Crystalline surgery, Cataract etiology
- Abstract
Background/objectives: Posterior Capsule Opacification (PCO) is the most common long-term post-operative adverse occurrence after cataract surgery often requiring treatment with YAG laser posterior capsulotomy. This study aimed to identify potential risk factors, known at the time of cataract surgery, that influence the development of PCO., Subject/methods: A retrospective study of publicly funded cataract surgery from The Royal College of Ophthalmologists' National Ophthalmology Database. Eligible for analysis were 500,872 cataract operations performed in 41 participating centres., Results: The 500,872 operations were performed on 243,167 (48.5%) left eyes and 257,705 (51.5%) right eyes from 373,579 patients by 2196 surgeons. Post-cataract PCO was recorded for 61,778 (12.3%) eyes and the six month, one, three, five and nine year observed rates of PCO were 2.3%, 4.4%, 19.7%, 34.0% and 46.9% respectively. Different PCO profiles were observed between IOL materials and the identified risk factors that increased the risk of developing PCO included hydrophilic IOL material, axial length >26 mm, the presence of high myopia and implantation of lower IOL powers and previous vitrectomy surgery, along with younger age and female gender., Conclusions: Many factors influence the development of PCO relating to the patient, the eye, the lens and the surgery. Some factors are modifiable such as IOL material, therefore the opportunity exists to attempt to reduce PCO rates, benefitting patients and the UK NHS., (© 2022. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)
- Published
- 2023
- Full Text
- View/download PDF
14. The influence of weather on the population dynamics of common mosquito vector species in the Canadian Prairies.
- Author
-
Baril C, Pilling BG, Mikkelsen MJ, Sparrow JM, Duncan CAM, Koloski CW, LaZerte SE, and Cassone BJ
- Subjects
- Animals, Mosquito Vectors, Grassland, Canada epidemiology, Weather, Population Dynamics, Culicidae, Culex, Aedes
- Abstract
Background: Mosquito seasonal activity is largely driven by weather conditions, most notably temperature, precipitation, and relative humidity. The extent by which these weather variables influence activity is intertwined with the animal's biology and may differ by species. For mosquito vectors, changes in weather can also alter host-pathogen interactions thereby increasing or decreasing the burden of disease., Methods: In this study, we performed weekly mosquito surveillance throughout the active season over a 2-year period in Manitoba, Canada. We then used Generalized Linear Mixed Models (GLMMs) to explore the relationships between weather variables over the preceding 2 weeks and mosquito trap counts for four of the most prevalent vector species in this region: Oc. dorsalis, Ae. vexans, Cx. tarsalis, and Cq. perturbans., Results: More than 265,000 mosquitoes were collected from 17 sampling sites throughout Manitoba in 2020 and 2021, with Ae. vexans the most commonly collected species followed by Cx. tarsalis. Aedes vexans favored high humidity, intermediate degree days, and low precipitation. Coquillettidia perturbans and Oc. dorsalis activity increased with high humidity and high rainfall, respectively. Culex tarsalis favored high degree days, with the relationship between number of mosquitoes captured and precipitation showing contrasting patterns between years. Minimum trapping temperature only impacted Ae. vexans and Cq. perturbans trap counts., Conclusions: The activity of all four mosquito vectors was affected by weather conditions recorded in the 2 weeks prior to trapping, with each species favoring different conditions. Although some research has been done to explore the relationships between temperature/precipitation and Cx. tarsalis in the Canadian Prairies, to our knowledge this is the first study to investigate other commonly found vector species in this region. Overall, this study highlights how varying weather conditions can impact mosquito activity and in turn species-specific vector potential., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
15. Surgeon effects on cataract refractive outcomes are minimal compared with patient comorbidity and gender: an analysis of 490 987 cases.
- Author
-
Hughes R, Aristodemou P, Sparrow JM, and Kaye S
- Subjects
- Humans, Male, Refraction, Ocular, Comorbidity, Vitreous Body, Retrospective Studies, Diabetic Retinopathy complications, Cataract complications, Glaucoma, Myopia, Retinal Diseases surgery, Optic Nerve Diseases complications, Surgeons, Phacoemulsification methods
- Abstract
Aim: To investigate effect of patient age, gender, comorbidities and surgeon on refractive outcomes following cataract surgery., Methods: Study population: patients on UK national ophthalmic cataract database on cataract operations undertaken between 1 April 2010 and 31 August 2018. Variables examined included gender, age, diabetic retinopathy, glaucoma, high myopia, inherited retinal disease, optic nerve disease, uveitis, pseudoexfoliation, vitreous opacities, retinal pathology, cataract type, previous surgery and posterior capsular rupture. A multivariate normal cross-classified model was fitted to the refractive outcome using Markov Chain Monte Carlo (MCMC) methods with diffuse priors to approximate maximum likelihood estimation. A MCMC chain was generated with a burn-in of 5000 iterations and a monitoring chain of 50 000 iterations., Results: 490 987 cataract operations were performed on 351 864 patients by 2567 surgeons. Myopic and astigmatic errors were associated with posterior capsule rupture (-0.38/+0.04×72), glaucoma (-0.10/+0.05×95), previous vitrectomy (-0.049/+0.03×66) and high myopia (-0.07/+0.03×57). Hyperopic and astigmatic errors were associated with diabetic retinopathy (+0.08/+0.03×104), pseudoexfoliation (+0.07/+0.01×158), male gender (+0.12/+0.05×91) and age (-0.01/+0.06×97 per increasing decade). Inherited retinal disease, optic nerve disease, previous trabeculectomy, uveitis, brunescent/white cataract had no significant impact on the error of the refractive outcome. The effect of patient gender and comorbidity was additive. Surgeons only accounted for 4% of the unexplained variance in refractive outcome., Conclusion: Patient comorbidities and gender account for small but statistically significant differences in refractive outcome, which are additive. Surgeon effects are very small., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2023
- Full Text
- View/download PDF
16. Developing decision support tools incorporating personalised predictions of likely visual benefit versus harm for cataract surgery: research programme
- Author
-
Sparrow JM, Grzeda M, Frost A, Liu C, Johnston RL, Scanlon P, Pithara C, Elliott D, Donovan J, Joseph-Williams N, Holland-Hart D, Donachie PHJ, Dixon P, Kandiyali R, Taylor H, Breheny K, Sterne J, Hollingworth W, Evans D, Fox F, Theodoropoulou S, Hughes R, Quinn M, Gray D, Benjamin L, Loose A, Edwards L, Craggs P, Paget F, Kapoor K, and Searle J
- Abstract
Background: Surgery for established cataract is highly cost-effective and uncontroversial, yet uncertainty remains for individuals about when to proceed and when to delay surgery during the earlier stages of cataract., Objective: We aimed to improve decision-making for cataract surgery through the development of evidence-based clinical tools that provide general information and personalised risk/benefit information., Design: We used a mixed methodology consisting of four work packages. Work package 1 involved the development and psychometric validation of a brief, patient self-reported measure of visual difficulty from cataract and its relief from surgery, named Cataract Patient-Reported Outcome Measure, five items (Cat-PROM5). Work package 2 involved the review and refinement of risk models for adverse surgical events (posterior capsule rupture and visual acuity loss related to cataract surgery). Work package 3 involved the development of prediction models for the Cat-PROM5-based self-reported outcomes from a cohort study of 1500 patients; assessment of the validity of preference-based health economic indices for cataract surgery and the calibration of these to Cat-PROM5; assessment of patients’ and health-care professionals’ views on risk–benefit presentation formats, the perceived usefulness of Cat-PROM5, the value of personalised risk–benefit information, high-value information items and shared decision-making; development of cataract decision aid frequently asked questions, incorporation of personalised estimates of risks and benefits; and development of a cataract decision quality measure to assess the quality of decision-making. Work package 4 involved a mixed-methods feasibility study for a fully powered randomised controlled trial of the use of the cataract decision aid and a qualitative study of discordant or mismatching perceptions of outcome between patients and health-care professionals., Setting: Four English NHS recruitment centres were involved: Bristol (lead centre), Brighton, Gloucestershire and Torbay. Multicentre NHS cataract surgery data were obtained from the National Ophthalmology Database., Participants: Work package 1 – participants ( n = 822) were from all four centres. Work package 2 – electronic medical record data were taken from the National Ophthalmology Database (final set > 1M operations). Work package 3 – cohort study participants were from Bristol ( n = 1200) and Gloucestershire ( n = 300); qualitative and development work was undertaken with patients and health-care professionals from all four centres. Work package 4 – Bristol, Brighton and Torbay participated in the recruitment of patients ( n = 42) for the feasibility trial and recruitment of health-care professionals for the qualitative elements., Interventions: For the feasibility trial, the intervention was the use of the cataract decision aid, incorporating frequently asked questions and personalised estimations of both adverse outcomes and self-reported benefit., Main Outcome Measures: There was a range of quantitative and qualitative outcome measures: questionnaire psychometric performance metrics, risk indicators of adverse surgical events and visual outcome, predictors of self-reported outcome following cataract surgery, patient and health-care practitioner views, health economic calibration measures and randomised controlled trial feasibility measures., Data Sources: The data sources were patient self-reported questionnaire responses, study clinical data collection forms, recorded interviews with patients and health-care professionals, and anonymised National Ophthalmology Database data., Results: Work package 1 – Cat-PROM5 was developed and validated with excellent to good psychometric properties (Rasch reliability 0.9, intraclass correlation repeatability 0.9, unidimensionality with residual eigenvalues ≤ 1.5) and excellent responsiveness to surgical intervention (Cohen delta –1.45). Work package 2 – earlier risk models for posterior capsule rupture and visual acuity loss were broadly affirmed ( C -statistic for posterior capsule rupture 0.64; visual acuity loss 0.71). Work package 3 – the Cat-PROM5-based self-reported outcome regression models were derived based on 1181 participants with complete data ( R
2 ≈ 30% for each). Of the four preference-based health economic indices assessed, two demonstrated reasonable performance. Cat-PROM5 was successfully calibrated to health economic indices; adjusted limited dependent variable mixture models offered good to excellent fit (root-mean-square error 0.10–0.16). The personalised quantitative risk information was generally perceived as beneficial. A cataract decision aid and cataract decision quality measure were successfully developed based on the views of patients and health-care professionals. Work package 4 – data completeness was good for the feasibility study primary and secondary variables both before and after intervention/surgery (data completeness range 100–88%). Considering ability to recruit, the sample size required, instrumentation and availability of necessary health economic data, a fully powered randomised controlled trial (patients, n = 800, effect size 0.2 standard deviations, power 80%; p = 0.05) of the cataract decision aid would be feasible following psychometric refinement of the primary outcome (the cataract decision quality measure). The cataract decision aid was generally well-received by patients and health-care professionals, with cautions raised regarding perceived time and workload barriers. Discordant outcomes mostly related to patient dissatisfaction, with no clinical problem found., Limitations: The National Ophthalmology Database data are expected to include some errors (mitigated by large multicentre data aggregations). The feasibility randomised controlled trial primary outcome (the cataract decision quality measure) displayed psychometric imperfections requiring refinement. The clinical occurrence of discordant outcomes is uncommon and the study team experienced difficulty identifying patients in this situation., Future Work: Future work could include regular review of the risk models for adverse outcomes to ensure currency, and the technical precision of complex-numbers analysis of refractive outcome to invite opportunities to improve post-operative spectacle-free vision. In addition, a fully powered randomised controlled trial of the cataract decision aid would be feasible, following psychometric refinement of the primary outcome (the cataract decision quality measure); this would clarify its potential role in routine service delivery., Conclusions: In this research programme, evidence-based clinical tools have been successfully developed to improve pre-operative decision-making in cataract surgery. These include a psychometrically robust, patient-reported outcome measure (Cat-PROM5); prediction models for patient self-reported outcomes using Cat-PROM5; prediction models for clinically adverse surgical events and adverse visual acuity outcomes; and a cataract decision aid with relevant general information and personalised risk/benefit predictions. In addition, the successful mapping of Cat-PROM5 to existing health economic indices was achieved and the performances of indices were assessed in patients undergoing cataract surgery. A future full-powered randomised controlled trial of the cataract decision aid would be feasible (patients, n = 800, effect size 0.2 standard deviations, power 80%; p = 0.05)., Trial Registration: This trial is registered as ISRCTN11309852., Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research ; Vol. 10, No. 9. See the NIHR Journals Library website for further project information., (Copyright © 2022 Sparrow et al. This work was produced by Sparrow et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaption in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.)- Published
- 2022
- Full Text
- View/download PDF
17. Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 8, cohort analysis of the relationship between intraoperative complications of cataract surgery and axial length.
- Author
-
Day AC, Norridge CFE, Donachie PHJ, Barnes B, and Sparrow JM
- Subjects
- Cohort Studies, Humans, Intraoperative Complications epidemiology, Intraoperative Complications etiology, Retrospective Studies, State Medicine, Visual Acuity, Cataract epidemiology, Cataract Extraction adverse effects, Ophthalmologists, Ophthalmology, Phacoemulsification
- Abstract
Objectives: To describe the relationships between axial length and intraoperative complications in patients undergoing cataract surgery., Design: Cohort analysis of the Royal College of Ophthalmologists' National Ophthalmology Database (RCOphth NOD)., Setting: 110 National Health Service Trusts in England, Health Boards in Wales, Independent Sector Treatment Centres and Guernsey., Participants: 820 354 patients, aged 18 years or older, undergoing cataract surgery. Eligible operations were those from centres with at least 50 operations with a recorded axial length measurement and age at surgery between 1 April 2010 and 31 August 2019., Interventions: Phacoemulsification where the primary intention was cataract surgery alone., Outcome Measures: Posterior capsule rupture (PCR) and other recorded intraoperative complications., Results: 1 211 520 eligible operations were performed by 3210 surgeons. The baseline axial length was <21 mm (short eyes) for 17 170 (1.4%) eyes, 21-28 mm (medium eyes) for 1 182 513 (97.6%) eyes and >28 mm (long eyes) for 11 837 (1.0%) eyes. The median age at surgery was younger for patients with long eyes than those with short or medium eyes. The rate of any intraoperative complication was higher for short eyes than medium or long with complication rates of 4.5%, 2.9% and 3.3%, respectively (p<0.001). PCR occurred in 1.40% surgeries overall, and in 1.53%, 1.40% and 1.61% of short, medium and long eyes, respectively (p=0.043, not significant at the 1% level)., Conclusions: Overall PCR rates for cataract surgery in RCOphth NOD contributing centres are lower than previously reported and there is little change in PCR rates by axial length. Short eyes were more likely to have an intraoperative complication than medium or long eyes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2022
- Full Text
- View/download PDF
18. Primary trabeculectomy versus primary glaucoma eye drops for newly diagnosed advanced glaucoma: TAGS RCT.
- Author
-
King AJ, Fernie G, Hudson J, Kernohan A, Azuara-Blanco A, Burr J, Homer T, Shabaninejad H, Sparrow JM, Garway-Heath D, Barton K, Norrie J, McDonald A, Vale L, and MacLennan G
- Subjects
- Aged, Cost-Benefit Analysis, Female, Humans, Male, Middle Aged, Ophthalmic Solutions, Quality of Life, Quality-Adjusted Life Years, Glaucoma, Glaucoma, Open-Angle drug therapy, Glaucoma, Open-Angle surgery, Trabeculectomy
- Abstract
Background: Patients diagnosed with advanced primary open-angle glaucoma are at a high risk of lifetime blindness. Uncertainty exists about whether primary medical management (glaucoma eye drops) or primary surgical treatment (augmented trabeculectomy) provide the best and safest patient outcomes., Objectives: To compare primary medical management with primary surgical treatment (augmented trabeculectomy) in patients with primary open-angle glaucoma presenting with advanced disease in terms of health-related quality of life, clinical effectiveness, safety and cost-effectiveness., Design: This was a two-arm, parallel, multicentre, pragmatic randomised controlled trial., Setting: Secondary care eye services., Participants: Adult patients presenting with advanced primary open-angle glaucoma in at least one eye, as defined by the Hodapp-Parrish-Anderson classification of severe glaucoma., Intervention: Primary medical treatment - escalating medical management with glaucoma eye drops. Primary trabeculectomy treatment - trabeculectomy augmented with mitomycin C., Main Outcome Measures: The primary outcome was health-related quality of life measured with the Visual Function Questionnaire-25 at 2 years post randomisation. Secondary outcomes were mean intraocular pressure; EQ-5D-5L; Health Utilities Index 3; Glaucoma Utility Index; cost and cost-effectiveness; generic, vision-specific and disease-specific health-related quality of life; clinical effectiveness; and safety., Results: A total of 453 participants were recruited. The mean age of the participants was 67 years (standard deviation 12 years) in the trabeculectomy arm and 68 years (standard deviation 12 years) in the medical management arm. Over 65% of participants were male and more than 80% were white. At 24 months, the mean difference in Visual Function Questionnaire-25 score was 1.06 (95% confidence interval -1.32 to 3.43; p = 0.383). There was no evidence of a difference between arms in the EQ-5D-5L score, the Health Utilities Index or the Glaucoma Utility Index. At 24 months, the mean intraocular pressure was 12.40 mmHg in the trabeculectomy arm and 15.07 mmHg in the medical management arm (mean difference -2.75 mmHg, 95% confidence interval -3.84 to -1.66 mmHg; p < 0.001). Fewer types of glaucoma eye drops were required in the trabeculectomy arm. LogMAR visual acuity was slightly better in the medical management arm (mean difference 0.07, 95% confidence interval 0.02 to 0.11; p = 0.006) than in the trabeculectomy arm. There was no evidence of difference in safety between the two arms. A discrete choice experiment updated the utility values for the Glaucoma Utility Index. The within-trial economic analysis found a small increase in the mean EQ-5D-5L score (0.04) and that trabeculectomy has a higher probability of being cost-effective than medical management. The incremental cost of trabeculectomy per quality-adjusted life-year was £45,456. Therefore, at 2 years, surgery is unlikely to be considered cost-effective at a threshold of £20,000 per quality-adjusted life-year. When extrapolated over a patient's lifetime in a model-based analysis, trabeculectomy, compared with medical treatment, was associated with higher costs (average £2687), a larger number of quality-adjusted life-years (average 0.28) and higher incremental cost per quality-adjusted life-year gained (average £9679). The likelihood of trabeculectomy being cost-effective at a willingness-to-pay threshold of £20,000 per quality-adjusted life year gained was 73%., Conclusions: Our results suggested that there was no difference between treatment arms in health-related quality of life, as measured with the Visual Function Questionnaire-25 at 24 months. Intraocular pressure was better controlled in the trabeculectomy arm, and this may reduce visual field progression. Modelling over the patient's lifetime suggests that trabeculectomy may be cost-effective over the range of values of society's willingness to pay for a quality-adjusted life-year., Future Work: Further follow-up of participants will allow us to estimate the long-term differences of disease progression, patient experience and cost-effectiveness., Trial Registration: Current Controlled Trials ISRCTN56878850., 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. 25, No. 72. See the NIHR Journals Library website for further project information.
- Published
- 2021
- Full Text
- View/download PDF
19. Factors affecting visual recovery after successful repair of macula-off retinal detachments: findings from a large prospective UK cohort study.
- Author
-
Yorston D, Donachie PHJ, Laidlaw DA, Steel DH, Sparrow JM, Aylward GW, and Williamson TH
- Subjects
- Cohort Studies, Humans, Male, Middle Aged, Prospective Studies, Retrospective Studies, Scleral Buckling, Time Factors, Treatment Outcome, United Kingdom epidemiology, Vitrectomy, Retinal Detachment surgery
- Abstract
Objective: To identify risk factors affecting visual outcomes in successfully re-attached macula-off rhegmatogenous retinal detachment (RD) surgery., Design: A prospective study, using online databases, of visual outcomes for 2074 macula-off retinal detachments that were successfully re-attached by vitrectomy and internal tamponade. The database included detailed retinal diagrams of each detachment., Main Outcome Measure: The probability of achieving a post-operative visual acuity (VA) of ≤0.30 LogMAR (Snellen 6/12 or better)., Results: Male patients accounted for 64.9% of the sample and the median age was 63 years old. The median pre-operative VA was counting fingers (LogMAR 1.98); this improved to 0.41 LogMAR post-operatively. A post-operative VA of ≤0.30 LogMAR was achieved for 1012 (48.8%) eyes and the factors affecting this were the patient age and gender, pre-operative VA, duration of central vision loss, PVR grade, lens status, total RD and the presence of any ocular co-pathology where the model area under the receiver operator curve was 71.6%., Conclusions: From the identified risk factors that decrease the probability of achieving a post-operative visual acuity of ≤0.30 LogMAR, the most important modifiable risk factor was the duration of central vision loss. Recent macula-off retinal detachments should be repaired within 72 h of the loss of central vision.
- Published
- 2021
- Full Text
- View/download PDF
20. The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: Report 7, immediate sequential bilateral cataract surgery in the UK: Current practice and patient selection.
- Author
-
Buchan JC, Donachie PHJ, Cassels-Brown A, Liu C, Pyott A, Yip JLY, Zarei-Ghanavati M, and Sparrow JM
- Subjects
- Aged, Humans, Patient Selection, United Kingdom epidemiology, Visual Acuity, Cataract, Cataract Extraction, Ophthalmologists, Ophthalmology
- Abstract
Background: Cataract extraction is the most frequently performed surgical intervention in the world and demand is rising due to an ageing demography. One option to address this challenge is to offer selected patients immediate sequential bilateral cataract surgery (ISBCS). This study aims to investigate patient and operative characteristics for ISBCS and delayed bilateral cataract surgery (DSCS) in the UK., Methods: Data were analysed from the Royal College of Ophthalmologists' National Ophthalmology Database Audit (NOD) of cataract surgery. Eligible patients were those undergoing bilateral cataract extraction from centres with a record of at least one ISBCS operation between 01/04/2010 and 31/08/2018. Variable frequency comparison was undertaken with chi-square tests., Results: During the study period, 1073 patients had ISBCS and 248,341 DSCS from 73 centres. A higher proportion of ISBCS patients were unable to lie flat (11.3% vs. 1.8%; p < 0.001), unable to cooperate (9.7% vs. 2.7%; p < 0.001); underwent general anaesthesia (58.7% vs. 6.6% (p < 0.001)); had brunescent/white/mature cataracts (odds ratio (OR) 5.118); no fundal view/vitreous opacities (OR 8.381); had worse pre-operative acuity 0.60 LogMAR ISBCS vs. 0.50 (first) and 0.40 (second eye) DSCS and were younger (mean ages, 71.5 vs. 75.6 years; p < 0.001). Posterior capsular rupture (PCR) rates adjusted for case complexity were comparable (0.98% ISBCS and 0.78% DSCS)., Conclusions: ISBCS was performed on younger patients, with difficulty cooperating and lying flat, worse pre-operative vision, higher rates of known PCR risk factors and more frequent use of general anaesthesia than DSCS in centres recorded on NOD.
- Published
- 2020
- Full Text
- View/download PDF
21. Progression from ocular hypertension to visual field loss in the English hospital eye service.
- Author
-
Kelly SR, Khawaja AP, Bryan SR, Azuara-Blanco A, Sparrow JM, and Crabb DP
- Subjects
- Aged, Databases, Factual, Disease Progression, Electronic Health Records, Female, Follow-Up Studies, Glaucoma, Open-Angle physiopathology, Hospitals, Special statistics & numerical data, Humans, Intraocular Pressure physiology, Male, Middle Aged, Ocular Hypertension physiopathology, Ophthalmology statistics & numerical data, Retrospective Studies, Risk Factors, Tonometry, Ocular, Vision Disorders physiopathology, Visual Acuity physiology, Visual Field Tests, Glaucoma, Open-Angle diagnosis, Ocular Hypertension diagnosis, State Medicine, Vision Disorders diagnosis, Visual Fields physiology
- Abstract
Background: There are more than one million National Health Service visits in England and Wales each year for patients with glaucoma or ocular hypertension (OHT). With the ageing population and an increase in optometric testing, the economic burden of glaucoma-related visits is predicted to increase. We examined the conversion rates of OHT to primary open-angle glaucoma (POAG) in England and assessed factors associated with risk of conversion., Methods: Electronic medical records of 45 309 patients from five regionally different glaucoma clinics in England were retrospectively examined. Conversion to POAG from OHT was defined by deterioration in visual field (two consecutive tests classified as stage 1 or worse as per the glaucoma staging system 2). Cox proportional hazards models were used to examine factors (age, sex, treatment status and baseline intraocular pressure (IOP)) associated with conversion., Results: The cumulative risk of conversion to POAG was 17.5% (95% CI 15.4% to 19.6%) at 5 years. Older age (HR 1.35 per decade, 95% CI 1.22 to 1.50, p<0.001) was associated with a higher risk of conversion. IOP-lowering therapy (HR 0.45, 95% CI 0.35 to 0.57, p<0.001) was associated with a lower risk of conversion. Predicted 5-year conversion rates for treated and untreated groups were 14.0% and 26.9%, respectively., Conclusion: Less than one-fifth of OHT patients managed in glaucoma clinics in the UK converted to POAG over a 5-year period, suggesting many patients may require less intensive follow-up. Our study provides real-world evidence for the efficacy of current management (including IOP-lowering treatment) at reducing risk of conversion., 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
- Full Text
- View/download PDF
22. Intraocular Pressure Reduction After Real-world Cataract Surgery.
- Author
-
Leal I, Chu CJ, Yang YY, Manasses DM, Sebastian RT, and Sparrow JM
- Subjects
- Aged, Aged, 80 and over, Female, Glaucoma surgery, Humans, Male, Middle Aged, Ocular Hypotension physiopathology, Ocular Hypotension surgery, Retrospective Studies, Tonometry, Ocular, Glaucoma physiopathology, Intraocular Pressure physiology, Lens Implantation, Intraocular, Phacoemulsification, Pseudophakia physiopathology
- Abstract
PRéCIS:: A large cohort undergoing cataract extraction was retrospectively analyzed to ascertain the degree of real-world intraocular pressure (IOP) reduction in normal eyes and those with glaucoma, and a predictive formula was developed., Purpose: The purpose of this study was to define the real-world degree of IOP reduction after cataract extraction to guide its role as an isolated intervention for glaucoma., Materials and Methods: A retrospective analysis was carried out of clinical data collected in 8 clinical sites in the United Kingdom from an electronic medical record system between January 2006 and May 2015. A total of 20,508 eyes without known pathology and 2251 eyes from patients with glaucoma undergoing phacoemulsification and intraocular lens insertion were included. Eyes with intraoperative complications, undergoing additional procedures, axial lengths outside 22 to 26.5 mm, preoperative IOP under 6 mm Hg or over 30 mm Hg, and copathology, except for amblyopia or glaucoma, were excluded. The main outcome measure was the change in preoperative IOP compared with the next recorded visit for up to 12 weeks., Results: In eyes without pathology, the mean reduction in IOP was 1.40 mm Hg (±3.74) compared with 1.03 (±5.02), P-value <0.001, in eyes with a diagnosis of glaucoma. A multiple linear regression model identified preoperative IOP, a glaucoma diagnosis, preoperative corrected visual acuity, age, and axial length as determinants of IOP reduction. The model was validated against an independent cohort., Conclusions: We quantify mean IOP reduction achieved in a real-world setting from cataract surgery alone. In glaucomatous eyes where angle closure is not differentiated, phacoemulsification alone yields only a modest reduction of IOP.
- Published
- 2020
- Full Text
- View/download PDF
23. Baseline Characteristics of Participants in the Treatment of Advanced Glaucoma Study: A Multicenter Randomized Controlled Trial.
- Author
-
King AJ, Hudson J, Fernie G, Burr J, Azuara-Blanco A, Sparrow JM, Barton K, Garway-Heath DF, Kernohan A, and MacLennan G
- Subjects
- Aged, Aged, 80 and over, Female, Glaucoma, Open-Angle physiopathology, Glaucoma, Open-Angle therapy, Humans, Intraocular Pressure physiology, Male, Middle Aged, Quality of Life psychology, Sickness Impact Profile, Vision Disorders physiopathology, Visual Acuity physiology, Visual Fields physiology, Antihypertensive Agents therapeutic use, Glaucoma, Open-Angle diagnosis, Trabeculectomy methods
- Abstract
Purpose: To report the baseline characteristics of participants enrolled in TAGS (Treatment of Advanced Glaucoma Study)., Design: Pragmatic randomized control trial (RCT)., Methods: Participants with newly diagnosed advanced glaucoma in at least 1 eye were recruited. Participants were patients with open angle glaucoma presenting with advanced glaucoma in at least 1 eye as defined by the Hodapp-Parrish-Anderson (HPA) criteria for severe defect. Participants were randomly allocated to receive either primary augmented trabeculectomy or primary medical management. When both eyes were eligible, the same intervention was undertaken in both eyes, and the index eye for analysis was the eye with the less severe visual field mean defect (MD). Main outcome measurements were visual field profile, defined by the HPA classification; clinical characteristics; quality of life, as measured by the National Eye Institute Visual Function Questionnaire 25 (VFQ-25), the EuroQual-5 Dimension (EQ-5D 5L), Health Utility Index-3 (HUI-3), and the Glaucoma Profile Instrument (GPI)., Results: A total of 453 patients were recruited. The mean visual field MD was -15.0 dB ± 6.3 in the index eye and -6.2 dB in the non-index eye. Of index eyes (HPA "severe" classification) at baseline, more than 70% of participants had a MD <-12.00 dB, and nearly 90% had more than 20 points defective at the 1% level. The mean LogMAR visual acuity of the index eye was 0.2 ± 0.3., Conclusions: TAGS is the first RCT to compare medical versus surgical treatments for patients presenting with advanced open angle glaucoma in a publicly funded health service. The study will provide clinical, health-related quality of life, and economic outcomes to inform future treatment choices for those presenting with advanced glaucoma., (Copyright © 2020. Published by Elsevier Inc.)
- Published
- 2020
- Full Text
- View/download PDF
24. Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 6. The impact of EyeSi virtual reality training on complications rates of cataract surgery performed by first and second year trainees.
- Author
-
Ferris JD, Donachie PH, Johnston RL, Barnes B, Olaitan M, and Sparrow JM
- Subjects
- Cataract Extraction education, Clinical Competence, Educational Measurement, Humans, Retrospective Studies, Cataract Extraction statistics & numerical data, Education, Medical, Graduate methods, Internship and Residency methods, Ophthalmology education, Simulation Training methods, Societies, Medical, Virtual Reality
- Abstract
Objective: To investigate the impact of EyeSi surgical simulators on posterior capsule rupture (PCR) rates of cataract surgery performed by first and second year trainee surgeons., Design: A Royal College of Ophthalmologists' National Ophthalmology Database audit study of first and second year surgeons' PCR rates over seven consecutive National Health Service (NHS) years. Participating centres were contacted to ascertain the date when their surgeons had access to an EyeSi machine and whether this was on-site or off-site. Operations were classified as before, after or no access to EyeSi., Setting: The study took place in 29 NHS Ophthalmology Units in a secondary care setting., Results: Two-hundred and sixty five first and second year trainee surgeons performed 17 831 cataract operations. 6919 (38.8%) operations were performed before access to an EyeSi, 8648 (48.5%) after access to an EyeSi and 2264 (12.7%) operations by surgeons with no access to an EyeSi. Overall, there was a 38% reduction in the first and second year surgeon's unadjusted PCR rates from 4.2% in 2009 to 2.6% in 2015 for surgeons with access to an EyeSi, and a 3% reduction from 2.9% to 2.8% for surgeons without access to an EyeSi. The overall first and second year unadjusted PCR rates for before, after and no access to EyeSi were 3.5%, 2.6% and 3.8%, respectively. The decrease in the with-access to an EyeSi group PCR rate was similar for surgeons with access to an EyeSi 'on site' or 'off site'., Conclusions: First and second year trainee surgeons' unadjusted PCR rates have decreased since 2009 which has significant benefits for patients undergoing cataract surgery. This 38% reduction in complication rates aligns with the introduction of EyeSi simulator training., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2020
- Full Text
- View/download PDF
25. The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 4, equity of access to cataract surgery.
- Author
-
Johnston RL, Day AC, Donachie PHJ, and Sparrow JM
- Subjects
- England, Health Services Accessibility, Humans, Retrospective Studies, State Medicine, Cataract epidemiology, Cataract Extraction, Ophthalmologists, Ophthalmology
- Abstract
Objective: To determine whether socioeconomic status influenced the presenting visual acuity prior to first eye cataract surgery in the English National Health Service. Retrospective case series from The Royal College of Ophthalmologists' National Ophthalmology Database Audit. In total 154,223 patients undergoing first eye cataract surgery at 68 centres in England performed between 1st September 2015 and 31st August 2017., Main Outcome Measure: Social deprivation status and pre-operative visual acuity (VA) between centres for patients undergoing first eye cataract surgery in England., Results: The median social deprivation varied between centres and ranged from decile 2 (2nd most deprived decile) to decile 9 (2nd least deprived decile). The pre-operative VA was reported for 143,401 (93.0%) eyes. The median pre-operative VA was 0.50 LogMAR (6/19), and 27.7% eyes had a preoperative VA of 0.30 LogMAR units (6/12) or better. The median pre-operative VA for each centre ranged from 0.30 to 0.60 LogMAR (6/12 to 6/24). The median pre-operative VA was mostly stable across deciles of social deprivation (0.60 LogMAR for decile 1 and 0.50 LogMAR for all other deciles), and some evidence was found linking greater deprivation to worse pre-operative VA and to lower levels of access., Conclusions: We found no strong evidence of inequality for gaining access to first eye cataract surgery in this National Ophthalmology Database analysis, however there was a possible trend towards fewer people in the more deprived deciles accessing surgery, and that some of these are presenting with quite marked levels of visual impairment.
- Published
- 2020
- Full Text
- View/download PDF
26. Auditing service delivery in glaucoma clinics using visual field records: a feasibility study.
- Author
-
Kelly SR, Bryan SR, Sparrow JM, and Crabb DP
- Abstract
Objective: This study aimed to demonstrate that large-scale visual field (VF) data can be extracted from electronic medical records (EMRs) and to assess the feasibility of calculating metrics from these data that could be used to audit aspects of service delivery of glaucoma care., Method and Analysis: Humphrey visual field analyser (HFA) data were extracted from Medisoft EMRs from five regionally different clinics in England in November 2015, resulting in 602 439 records from 73 994 people. Target patients were defined as people in glaucoma clinics with measurable and sustained VF loss in at least one eye (HFA mean deviation (MD) outside normal limits ≥2 VFs). Metrics for VF reliability, stage of VF loss at presentation, speed of MD loss, predicted loss of sight years (bilateral VF impairment) and frequency of VFs were calculated., Results: One-third of people (34.8%) in the EMRs had measurable and repeatable VF loss and were subject to analyses (n=25 760 patients). Median (IQR) age and presenting MD in these patients were 71 (61, 78) years and -6 (-10, -4) dB, respectively. In 19 264 patients with >4 years follow-up, median (IQR) MD loss was -0.2 (-0.8, 0.3) dB/year and median (IQR) intervals between VF examinations was 11 (8, 16) months. Metrics predicting loss of sight years and reliability of examinations varied between centres (p<0.001)., Conclusion: This study illustrates the feasibility of assessing aspects of health service delivery in glaucoma clinics through analysis of VF databases. Proposed metrics could be useful for blindness prevention from glaucoma in secondary care centres., Competing Interests: Competing interests: DPC reports speaker fees from Allergan, Bayer, Santen; unrestricted funding from Allergan, Roche, Santen; consultancy with Centervue—all outside the remit of the submitted work.
- Published
- 2019
- Full Text
- View/download PDF
27. The Royal College of Ophthalmologists' National Ophthalmology Database Study of cataract surgery. Report 5: Clinical outcome and risk factors for posterior capsule rupture and visual acuity loss following cataract surgery in patients aged 90 years and older.
- Author
-
Theodoropoulou S, Grzeda MT, Donachie PHJ, Johnston RL, Sparrow JM, and Tole DM
- Subjects
- Aged, 80 and over, Female, Humans, Male, Posterior Capsular Rupture, Ocular etiology, Prognosis, Risk Factors, United Kingdom epidemiology, Cataract Extraction adverse effects, Intraoperative Complications, Ophthalmology statistics & numerical data, Posterior Capsular Rupture, Ocular epidemiology, Risk Assessment methods, Societies, Medical statistics & numerical data, Visual Acuity
- Abstract
Background: Older age is commonly associated with an increased risk of surgical complications and comparatively poor outcomes., Purpose: To report cataract surgery outcomes and risk indicators for patients aged 90 years and older., Methods: Data collected as part of routine cataract care in 34 centres contributing to the United Kingdom Royal College of Ophthalmologists' National Ophthalmology Database (NOD) were analysed. Very elderly people undergoing cataract surgery were profiled in terms of demographics, pre- and postoperative best-measured visual acuity (VA), ocular co-morbidities, intraoperative posterior capsule rupture (PCR) or vitreous loss or both, and risk indicators for operative PCR and adverse VA outcome., Results: 25,856 cataract operations in 19,166 people of 90 years or older between 2000 and 2014 are reported. Preoperative VA was available for 82.4% eyes, being 0.30 LogMAR or better in 21.5%. Postoperative VA was available for 61.8% eyes, being 0.30 LogMAR or better in 74.4%. For those without ocular co-morbidity, postoperative VA was 0.30 LogMAR or better in 84.7%. Various co-morbidities were present in 49% and contributed to an adverse VA outcome. PCR data were available for all operations and occurred in 2.7%. Significant risk indicators for PCR included pseudoexfoliation/phakodonesis, mature cataract, smaller pupil and worse preoperative VA., Conclusions: Slightly poorer cataract surgery outcome results were noted in patients of 90 years or older, more so in patients with ocular co-morbidity which was highly prevalent. However, surgeons should not be deterred from offering cataract surgery to the very elderly as successful visual rehabilitation remains achievable.
- Published
- 2019
- Full Text
- View/download PDF
28. Going paperless: improved cataract surgery outcome data quality in a new fully electronic unit.
- Author
-
Nghiem AZ, Canning C, Eason J, Sparrow JM, and Flynn TH
- Subjects
- Aged, Data Accuracy, Female, Follow-Up Studies, Humans, Incidence, Male, Retrospective Studies, United Kingdom epidemiology, Visual Acuity, Cataract Extraction statistics & numerical data, Electronic Health Records organization & administration, Intraoperative Complications epidemiology, Ophthalmology statistics & numerical data, Postoperative Complications epidemiology, Quality Improvement, Registries
- Abstract
Objectives: To report outcome data on the first 5000 consecutive cataract cases at a new paperless eye unit and benchmark against the Royal College of Ophthalmologists' National Ophthalmology Database (RCOphth NOD)., Methods: Using the in-built audit tool of the electronic medical records system, data from all cataract operations performed between 1 April 2014 and 13 January 2017 were compiled., Results: Five thousand and eight cases were recorded of which the overall intra-operative complication rate was 2.4%, the most common being posterior capsular rupture-1.14%. Follow-up data on post-operative complications were recorded in 98.6% of cases. Pre- and post-operative visual acuities was measured in 98.0% of cases. In all, 40.8% of eyes achieved a visual acuity of 6/6 or better and 90.7% achieved 6/12 or better., Conclusions: A data set of >5000 consecutive cataract operations was obtained in this eye department. The recording of pre- and post-operative visual acuity in 98% of cases compare very favourably to the RCOphth NOD Audit Report 2017 where pre- and post-operative visual acuities were recorded in only 57.1% of operations. Despite this difference, the outcome measures from this unit and RCOphth NOD were very similar, validating the results of the RCOphth NOD audit reports. Significantly, when applying the RCOphth NOD audit criteria for measuring post-operative visual acuity, approximately 15% of cases were excluded from the data set, reducing the completeness of the data set. Paperless ophthalmology units are feasible in today's NHS and can produce near complete cataract data sets; this can ultimately lead to more comprehensive and reliable aggregate cataract outcome data.
- Published
- 2019
- Full Text
- View/download PDF
29. Evaluating Refractive Outcomes after Cataract Surgery.
- Author
-
Aristodemou P, Sparrow JM, and Kaye S
- Subjects
- Aged, Axial Length, Eye, Biometry, Databases, Factual, Female, Humans, Male, Middle Aged, Postoperative Period, Treatment Outcome, Visual Acuity physiology, Cornea physiopathology, Lens Implantation, Intraocular, Phacoemulsification methods, Pseudophakia physiopathology, Refraction, Ocular physiology, Refractive Errors physiopathology
- Abstract
Purpose: To compare methods for evaluating refractive outcomes after cataract surgery to detect outliers., Design: Case series database study of the evaluation of diagnostic technology., Participants: Consecutive patients who had uneventful cataract operations over a 5-year period., Methods: The intended and postoperative refractive outcome and differences between these were analyzed as a spherical equivalent, cylinder, and spherocylinder. The average keratometry and differences between steep and flat keratometric meridians were used to calculate the intended refractive error., Main Outcome Measures: Outliers were defined as patients for whom the difference between the intended and postoperative refractive errors was more than 3 standard deviations (SDs) away from the mean., Results: A total of 9000 patients were included. Twelve patients had missing data and were excluded. The mean intended refractive outcome was -0.12+0.12×2 (95% lower confidence limit [LCL], -1.94+1.06×44; 95% upper confidence limit [UCL], +0.77+1.05×140). The actual postoperative refractive error was -0.30+0.47×6 (95% LCL, -2.36+1.31×36; 95% UCL, +1.00+1.18×148) with a difference from the intended of -0.18+0.35×7 (95% LCL, -1.91+1.22×38; 95% UCL, +0.75+1.09×145). Treating the components of the refractive error independently, outliers were observed in 82 eyes (0.91%) based on the sphere, 46 eyes (0.51%) based on the spherical equivalent, 115 eyes (1.28%) based on treating the cylinder as a scalar, and 76 eyes (0.85%) based on treating the cylinder as a vector. When the differences between the intended and postoperative refractive errors were calculated as a compound spherocylinder, outliers were observed for 233 eyes (2.59%)., Conclusions: Treating the intended refractive outcome as a spherocylinder improves the precision for detecting clinically significant refractive outliers., (Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
30. A randomized controlled trial comparing femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery.
- Author
-
Roberts HW, Wagh VK, Sullivan DL, Hidzheva P, Detesan DI, Heemraz BS, Sparrow JM, and O'Brart DPS
- Subjects
- Aged, Aged, 80 and over, Case-Control Studies, Female, Humans, Lens Implantation, Intraocular, Male, Middle Aged, Prospective Studies, Pseudophakia physiopathology, Quality of Life, Refraction, Ocular physiology, Surveys and Questionnaires, Visual Acuity physiology, Cataract Extraction methods, Laser Therapy methods, Phacoemulsification methods
- Abstract
Purpose: To compare the clinical results of conventional phacoemulsification surgery (CPS) with femtosecond laser-assisted cataract surgery., Setting: Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom., Design: Single-center prospective randomized interventional case-controlled trial., Methods: Patients undergoing cataract surgery were randomized to receive either CPS or femtosecond laser-assisted cataract surgery. The surgery was performed with a femtosecond laser (Lensx), and all operations were performed with a gravity-fluidics torsional phacoemulsification machine (Infiniti). The visual acuity, refraction, central corneal thickness (CCT), central foveal thickness (CFT), endothelial cell loss, and rates of intraoperative and postoperative events were recorded. Quality of life outcomes were measured with the EuroQOL 5 dimensions questionnaire (EQ-5D) and patient-reported quality of vision was assessed with a cataract surgery patient-reported outcome measures questionnaire (Cat-PROM5)., Results: The study comprised 400 eyes of 400 patients who had CPS (n = 200) or femtosecond laser-assisted cataract surgery (n = 200). Seven patients (3.5%) in the femtosecond laser-assisted group were not able to complete the treatment and received CPS. The mean uncorrected distance visual acuity (logarithm of the minimum angle of resolution [logMAR]) 0.15 ± 0.21 (SD) and 0.15 ± 0.19 logMAR after CPS and femtosecond laser-assisted surgery, respectively (P = 1.0); the pinhole-corrected visual acuity was 0.04 ± 0.12 and 0.04 ± 0.12, respectively (P = 1.0); the increase in CCT was 13 ± 19 μm and 15 ± 25 μm, respectively (P = .5); and the endothelial cell loss was 9.7 ± 13.7 % and 10.2% ± 13.7, respectively (P = .76). The manifest refraction spherical equivalent error was -0.14 ± 0.60 diopters (D) after CPS and -0.12 ± 0.60 D after femtosecond laser-assisted surgery (P = .74); the mean change in CFT was 9 ± 35 μm and 6 ± 35 μm, respectively (P = .55); and the rate of posterior capsule rupture was 3% and 0%, respectively (P = .03)., Conclusions: This study confirms the nonsignificant differences between 2 treatment modalities, notwithstanding a significant reduction in posterior capsule ruptures in the femtosecond laser-assisted surgery group., (Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
31. Treatment of Advanced Glaucoma Study: a multicentre randomised controlled trial comparing primary medical treatment with primary trabeculectomy for people with newly diagnosed advanced glaucoma-study protocol.
- Author
-
King AJ, Fernie G, Azuara-Blanco A, Burr JM, Garway-Heath T, Sparrow JM, Vale L, Hudson J, MacLennan G, McDonald A, Barton K, and Norrie J
- Subjects
- Aged, Antihypertensive Agents economics, Cost-Benefit Analysis, Female, Glaucoma, Open-Angle economics, Glaucoma, Open-Angle physiopathology, Health Status, Humans, Intraocular Pressure physiology, Male, Middle Aged, Prospective Studies, Quality of Life, Quality-Adjusted Life Years, Research Design, Sickness Impact Profile, Trabeculectomy economics, Treatment Outcome, Visual Acuity physiology, Visual Fields physiology, Antihypertensive Agents therapeutic use, Glaucoma, Open-Angle drug therapy, Glaucoma, Open-Angle surgery, Trabeculectomy methods
- Abstract
Background: Presentation with advanced glaucoma is the major risk factor for lifetime blindness. Effective intervention at diagnosis is expected to minimise risk of further visual loss in this group of patients., Aim: To compare clinical and cost-effectiveness of primary medical management compared with primary surgery for people presenting with advanced open-angle glaucoma (OAG)., Methods: Design : A prospective, pragmatic multicentre randomised controlled trial (RCT)., Setting: Twenty-seven UK hospital eye services., Participants: Four hundred and forty patients presenting with advanced OAG, according to the Hodapp-Parish-Anderson classification of visual field loss., Intervention: Participants will be randomised to medical treatment or augmented trabeculectomy (1:1 allocation minimised by centre and presence of advanced disease in both eyes)., Main Outcome Measures: The primary outcome is vision-related quality of life measured by the National Eye Institute-Visual Function Questionnaire-25 at 24 months. Secondary outcomes include generic EQ-5D-5L, Health Utility Index-3 and glaucoma-related health status (Glaucoma Utility Index), patient experience, visual field measured by mean deviation value, logarithm of the mean angle of resolution visual acuity, intraocular pressure, adverse events, standards for driving and eligibility for blind certification. Incremental cost per quality-adjusted life-year (QALY) based on EQ-5D-5L and glaucoma profile instrument will be estimated., Results: The study will report the comparative effectiveness and cost-effectiveness of medical treatment against augmented trabeculectomy in patients presenting with advanced glaucoma in terms of patient-reported health and visual function, clinical outcomes and incremental cost per QALY at 2 years., Conclusions: Treatment of Advanced Glaucoma Study will be the first RCT reporting outcomes from the perspective of those with advanced glaucoma., Trial Registration Number: ISRCTN56878850, Pre-results., Competing Interests: Competing interests: TAGS is funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number 12/35/38). JMB, GM, AM and JMS report grants from NIHR Health Technology Assessment Programme during the conduct of the study. LV reports grants from NIHR HTA Programme during the conduct of the study; and membership of the NIHR Health Technology Assessment Programme and a director of the NIHR Research Design Service. JN reports grants from NIHR HTA during the conduct of the study; personal fees from NIHR Editors Board, other from NIHR HTA General Board, 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.)
- Published
- 2018
- Full Text
- View/download PDF
32. Cataract surgery patient-reported outcome measures: a head-to-head comparison of the psychometric performance and patient acceptability of the Cat-PROM5 and Catquest-9SF self-report questionnaires.
- Author
-
Sparrow JM, Grzeda MT, Frost NA, Johnston RL, Liu CSC, Edwards L, Loose A, Elliott D, and Donovan JL
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Reproducibility of Results, United Kingdom, Cataract Extraction, Patient Acceptance of Health Care statistics & numerical data, Patient Reported Outcome Measures, Psychometrics instrumentation, Surveys and Questionnaires standards
- Abstract
Background Cataract surgery is the most frequently undertaken NHS surgical procedure. Visual acuity (VA) provides a poor indication of visual difficulty in a complex visual world. In the absence of a suitable outcome metric, recent efforts have been directed towards the development of a cataract patient-reported outcome measure (PROM) of sufficient brevity, precision, and responsiveness to be implementable in routine high volume clinical services.Aim To compare and contrast the two most promising candidate PROMs for routine cataract surgery.Method The psychometric performance and patient acceptability of the recently UK developed five-item Cat-PROM5 questionnaire was compared with the English translation of the Swedish nine-item Catquest-9SF using Rasch-based performance metrics and qualitative semistructured interviews.Results Rasch-based performance was assessed in 822 typical NHS cataract surgery patients across four centres in England. Both questionnaires demonstrated good to excellent performance for all metrics assessed, including Person Reliability Indices of 0.90 (Cat-PROM5) and 0.88 (Catquest-9SF), responsiveness to surgery (Cohen's standardized effect size) of 1.45 SD (Cat-PROM5) and 1.47 SD (Catquest-9SF) and they were highly correlated with each other (R=0.85). Qualitative assessments confirmed that both questionnaires were acceptable to patients, including in the presence of ocular comorbidities. Preferences were expressed for the shorter Cat-PROM5, which allowed patients to map their own issues to the questions as opposed to the more restrictive specific scenarios of Catquest-9SF.Conclusion The recently UK developed Cat-PROM5 cataract surgery questionnaire is shorter, with performance and patient acceptability at least as good or better than the previous 'best of class' Catquest-9SF instrument.
- Published
- 2018
- Full Text
- View/download PDF
33. Cat-PROM5: a brief psychometrically robust self-report questionnaire instrument for cataract surgery.
- Author
-
Sparrow JM, Grzeda MT, Frost NA, Johnston RL, Liu CSC, Edwards L, Loose A, and Donovan JL
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Prospective Studies, Quality of Life, Reproducibility of Results, United Kingdom, Cataract Extraction, Patient Reported Outcome Measures, Psychometrics instrumentation, Surveys and Questionnaires standards
- Abstract
PurposeTo develop a short, psychometrically robust and responsive cataract patient reported outcome measure suitable for use in high-volume surgical environments.MethodsA prospective study in which participants completed development versions of questionnaires exploring the quality of their eyesight using items harvested from two existing United Kingdom developed parent questionnaires. Participants were 822 patients awaiting cataract surgery recruited from 4 cataract surgical centres based in the UK. Exclusion criteria were other visually significant comorbidities and age <50 years. An iterative multi-stage process of evaluation using Rasch and factor analyses with sequential item reduction was undertaken.ResultsA definitive item set of just five items delivered performance in accordance with the requirements of the Rasch model: no threshold disordering, no misfitting items, Rasch-based reliability 0.90, person separation 2.98, Cronbach's α 0.89, good targeting of questions to patients with cataract with pre-operative item mean -0.41 logits and absence of significant floor or ceiling effects, minor deviations of item invariance, and confirmed unidimensionality. The test-re-test repeatability intra-class correlation coefficient was 0.89 with excellent responsiveness to surgery, Cohen's d -1.45 SD. Rasch calibration values are provided for Cat-PROM5 users.ConclusionsA psychometrically robust and highly responsive five-item cataract surgery patient reported outcome measure has been developed, which is suitable for use in high-volume cataract surgical services.
- Published
- 2018
- Full Text
- View/download PDF
34. ROYAL COLLEGE OF OPHTHALMOLOGISTS' NATIONAL DATABASE STUDY OF VITREORETINAL SURGERY: Report 7, Intersurgeon Variations in Primary Rhegmatogenous Retinal Detachment Failure.
- Author
-
Sallam AB, Donachie PHJ, Yorston D, Steel DHW, Williamson TH, Jackson TL, Sparrow JM, and Johnston RL
- Subjects
- Adult, Databases, Factual statistics & numerical data, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Failure, United Kingdom epidemiology, Ophthalmologists statistics & numerical data, Ophthalmology organization & administration, Postoperative Complications epidemiology, Registries, Retinal Detachment surgery, Societies, Medical statistics & numerical data, Vitreoretinal Surgery
- Abstract
Background/purpose: To audit variations in primary rhegmatogenous retinal detachment (RD) anatomical failure rates between surgeons, grades of surgeons, and techniques of RD surgery., Methods: Clinical data of a total of 5,857 eyes undergoing primary RD surgery, from 2000 to 2013 were retrospectively extracted from 15 centers using the same commercially available electronic medical record system, from three vitreoretinal units using an in-house electronic medical record, and from the British and Eire Association of Vitreoretinal Surgeons online registry., Results: The 5,857 primary RD operations were performed by 117 surgeons: 3,349 (57.2%) by consultants, 520 (8.9%) by independent nonconsultants, and 1,988 (33.9%) by trainees. Surgery comprised pars plana vitrectomy for 4,666 (79.7%) operations, scleral buckle for 815 (13.9%), and pars plana vitrectomy + scleral buckle for 376 (6.4%). The RD reoperation rate at 6 months after primary surgery was 13.9% (725/5,202) and did not differ significantly between consultants and trainees (P = 0.382). For surgeons contributing ≥50 cases, the mean (range) reoperation rates were 13.1% (6.7%-26.8%), 15.1% (11.3%-18.2%), and 15.3% (9.4%-22.1%) for consultants, independent nonconsultants, and trainee surgeons, respectively. The scleral buckle failure rate was not significantly different from pars plana vitrectomy (P = 0.095). Data were not adjusted for case-mix complexity., Conclusion: The grades of surgeons and the technique of surgery were not associated with a significant difference in primary unadjusted RD failure rates.
- Published
- 2018
- Full Text
- View/download PDF
35. The Royal College of Ophthalmologists' Glaucoma Commissioning Guidance: executive summary.
- Author
-
Khawaja AP, Sherratt MA, and Sparrow JM
- Subjects
- Critical Pathways organization & administration, Glaucoma prevention & control, Humans, United Kingdom, Community Health Services organization & administration, Glaucoma therapy, Ophthalmology organization & administration
- Published
- 2017
- Full Text
- View/download PDF
36. United Kingdom National Ophthalmology Database Study of Cataract Surgery: Report 3: Pseudophakic Retinal Detachment.
- Author
-
Day AC, Donachie PHJ, Sparrow JM, and Johnston RL
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Middle Aged, Posterior Capsular Rupture, Ocular surgery, Retinal Detachment surgery, Retrospective Studies, Risk Factors, State Medicine, Time Factors, United Kingdom, Cataract Extraction adverse effects, Databases, Factual, Posterior Capsular Rupture, Ocular etiology, Pseudophakia etiology, Retinal Detachment etiology
- Abstract
Purpose: To investigate time to pseudophakic retinal detachment (RD) after cataract surgery with posterior capsule rupture (PCR) to provide an evidence-based guide for postoperative management., Design: Retrospective case series., Participants: A total of 61 907 eyes of 46 824 patients undergoing cataract surgery., Methods: Subanalysis of the United Kingdom Royal College of Ophthalmologists' National Ophthalmology Database from 13 sites where data on both cataract and vitreoretinal surgery were recorded on the same electronic medical records system. Overall, 61 907 cataract operations were performed between October 2006 and August 2010. Analyses were restricted to cases with at least 3 months of potential postoperative follow-up., Results: Pseudophakic RD surgery was performed on 131 eyes of 129 patients (0.21%; 95% confidence interval [CI], 0.18%-0.25%). Of these, 36 were in eyes that had PCR during cataract surgery (3.27%; 95% CI, 2.37%-4.50%) and 95 were in eyes that did not have PCR (0.16%; 95% CI, 0.13%-0.19%). For eyes that progressed to RD surgery, the median time to pseudophakic RD surgery was 44 days for eyes with PCR, and 6.3 months for eyes without PCR. For all eyes (both with and without PCR), pseudophakic RD occurred earlier in cases performed by a trainee cataract surgeon., Conclusions: Pseudophakic RD occurs earlier after cataract surgery complicated by PCR. Surgeon grade is a risk factor for pseudophakic RD. Posterior vitreous detachment and RD symptoms should be discussed with patients who undergo cataract surgery and have PCR to facilitate early attendance, and careful dilated postoperative examination for retinal tears is recommended in the first 2 months after surgery., (Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
37. The Royal College of Ophthalmologists' National Ophthalmology Database Study of vitreoretinal surgery: report 5, anaesthetic techniques.
- Author
-
Sallam AA, Donachie PH, Williamson TH, Sparrow JM, and Johnston RL
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anesthesia, General methods, Anesthesia, Local methods, Anesthetics, General administration & dosage, Anesthetics, Local administration & dosage, Child, Child, Preschool, Female, Humans, Infant, Male, Middle Aged, Prospective Studies, Scleral Buckling, United Kingdom, Vitrectomy, Anesthesia, General trends, Anesthesia, Local trends, Databases, Factual statistics & numerical data, National Health Programs statistics & numerical data, Ophthalmology organization & administration, Societies, Medical statistics & numerical data, Vitreoretinal Surgery
- Abstract
Aims: To explore trends over time and variation in the use of anaesthetic techniques for vitreoretinal (VR) surgery in the UK., Methods: Prospectively collected data from 13 centres contributing >50 VR operations, including either pars plana vitrectomy (PPV) or scleral buckle (SB), between May 2000 and November 2010 were retrospectively analysed. Anaesthesia was categorised as general anaesthesia (GA) or local anaesthesia (LA) and results were reported by year, centre, grade of surgeon and type of operation., Results: 160 surgeons performed 12 124 operations on 10 405 eyes (9935 patients); 6054 (49.9%) under GA and 6070 (50.1%) under LA. The percentage performed under GA decreased from 95.3% in 2001 to 40.9% in 2010. Within LA techniques, peribulbar or retrobulbar injection was used in 2783 (45.8%) operations and sub-Tenon's cannula in 3287 (54.2%). The proportions of operations performed under GA or LA were similar for consultants and trainees. Primary SB, primary combined PPV and SB for retinal detachment (RD), repeat RD surgery and complex vitrectomy surgery were more commonly performed under GA (85.8%, 67.0%, 63.5% and 69.4%, respectively), while primary PPV for RD, simple vitrectomy surgery and macular surgery were more commonly performed under LA (58.1%, 53.7% and 58.2%, respectively). Marked intercentre variation existed with the extremes being one centre with 100% of operations performed under GA and one centre with 98.3% under LA., Conclusions: LA for VR surgery has steadily increased over the last decade in the UK but marked intercentre variation exists., (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
- Full Text
- View/download PDF
38. The Royal College of Ophthalmologists' National Ophthalmology Database Study of Vitreoretinal Surgery: Report 6, Diabetic Vitrectomy.
- Author
-
Jackson TL, Johnston RL, Donachie PH, Williamson TH, Sparrow JM, and Steel DH
- Subjects
- Adult, Aged, Cataract Extraction statistics & numerical data, Databases, Factual statistics & numerical data, Diabetic Retinopathy physiopathology, Endotamponade, Female, Humans, Male, Medical Audit, Middle Aged, Ophthalmology organization & administration, Prospective Studies, Retinal Detachment surgery, Societies, Medical, United Kingdom, Visual Acuity physiology, Cataract etiology, Diabetic Retinopathy surgery, Intraoperative Complications, Retinal Detachment etiology, Vitrectomy adverse effects, Vitreoretinal Surgery
- Abstract
Importance: Patients and clinicians need to accurately assess the risks and benefits of pars plana vitrectomy for proliferative diabetic retinopathy, but clinical trial data may not reflect real-world experience., Objective: To prospectively audit the complications of vitrectomy for proliferative diabetic retinopathy and help establish benchmarks., Design, Setting, and Participants: Royal College of Ophthalmologists' National Ophthalmology Database study of 939 eyes of 834 patients undergoing primary vitrectomy for proliferative diabetic retinopathy at 16 different vitreoretinal units in the United Kingdom. Data were obtained for the period from January 2001 to November 2010., Interventions: Pars plana vitrectomy with or without delamination/segmentation., Main Outcomes and Measures: Descriptions of the primary procedures performed, intraoperative complication rate, and proportion of eyes undergoing further surgery. An exploratory analysis of visual outcome was undertaken, with visual success and visual loss defined as a gain or reduction of 0.3 logMAR or more, respectively (approximately 2 Snellen lines), 6 to 12 months after surgery., Results: Of 420 eyes (among 408 patients) that underwent vitrectomy without delamination, the intraoperative complication rate was 13.1% (95% CI, 10.2%-16.7% [55 of 420 eyes]), with 126 eyes (30.0%) requiring an intravitreal tamponade and 49 eyes (11.7%) undergoing further vitrectomy (median follow-up, 6.9 months); 17.9% of 127 phakic eyes developed cataracts within a year, with 63.6% achieving visual success and 8.2% visual loss. Of 519 eyes (among 463 patients) that underwent vitrectomy with delamination, the intraoperative complication rate was 30.4% (95% CI, 26.6%-34.5% [158 of 519 eyes]), with 299 eyes (57.6%) requiring an intravitreal tamponade and 78 eyes (15.0%) undergoing further vitrectomy (median follow-up, 7.1 months); 21.2% of 126 phakic eyes developed cataracts within a year, with 62.8% achieving visual success and 14.9% visual loss., Conclusions and Relevance: Diabetic vitrectomy has an appreciable complication rate, particularly if delamination or segmentation are required. Nonetheless, the data available on visual acuity suggest that a majority of patients achieve clinically meaningful gains in vision.
- Published
- 2016
- Full Text
- View/download PDF
39. Sequential Hypothesis Testing to Characterise the Learning Curve and Monitor Surgical Performance in Retinal Detachment Surgery.
- Author
-
Keller J, Haynes RJ, and Sparrow JM
- Subjects
- Cryotherapy, Endotamponade, Humans, Medical Staff, Hospital, Monitoring, Intraoperative, Quality Assurance, Health Care, Scleral Buckling, Vitrectomy, Clinical Competence standards, Educational Measurement, Learning Curve, Ophthalmologic Surgical Procedures education, Retinal Detachment surgery
- Abstract
Purpose: To characterise the learning curve of primary retinal detachment (RD) repair for trainee surgeons and monitor the outcomes of surgery for established surgeons., Procedures: Primary RD operations were analysed sequentially using the cumulative sum (CUSUM) and the sequential probability ratio test (SPRT)., Results: 359 analysed cases of primary RD were audited with a recurrent RD (ReRD) rate of 14.7%. The individual rate of ReRD ranged from 9.4 to 17.4% (p = 0.74). SPRT and CUSUM analyses showed that ReRD occurred at random when operated by senior surgeons but a learning curve was discernible for junior surgeons. There was a trend for a higher proportion of ReRD caused by untreated breaks in cases operated by junior surgeons (p = 0.75)., Conclusion: SPRT and CUSUM are useful methods to monitor surgical outcomes and should be included in audits of sequential operations such as RD. Trainee surgeons experience a quantifiable learning curve., (© 2016 S. Karger AG, Basel.)
- Published
- 2016
- Full Text
- View/download PDF
40. The Royal College of Ophthalmologists' National Ophthalmology Database Study of cataract surgery: report 2, relationships of axial length with ocular copathology, preoperative visual acuity, and posterior capsule rupture.
- Author
-
Day AC, Donachie PH, Sparrow JM, and Johnston RL
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Preoperative Period, Prospective Studies, Societies, Medical, United Kingdom, Vitreous Body pathology, Axial Length, Eye pathology, Cataract Extraction statistics & numerical data, Databases, Factual, Eye Diseases epidemiology, Ophthalmology statistics & numerical data, Posterior Capsular Rupture, Ocular epidemiology, Visual Acuity physiology
- Abstract
Purpose: To describe the relationships of axial length with ocular copathology, preoperative visual acuity, and posterior capsule rupture rates in patients undergoing cataract surgery.DesignThe Royal College of Ophthalmologists' National Ophthalmology Database (NOD) study., Methods: Anonymised data on 180 114 eyes from 127 685 patients undergoing cataract surgery between August 2006 and November 2010 were collected prospectively from 28 sites. Data parameters included: demographics, biometry, ocular copathology, visual acuity measurements, and surgical complications including posterior capsule rupture, or vitreous loss or both (PCR)., Results: Consultant surgeons performed a higher proportion of operations on eyes whose axial length were at the extremes. Glaucoma and age related macular degeneration were more common in eyes with shorter axial lengths, whilst previous vitrectomy was associated with longer axial lengths. Eyes with brunescent or white cataracts or amblyopia were more common at both axial length extremes. Preoperative visual acuities were similar for eyes with axial length measurements up to approximately 28 mm and worse for eyes with longer axial length measurements. PCR rates showed little change with axial length (overall mean 1.95%, 95% CI: 1.89 to 2.01%), except for a borderline increase in eyes with axial length <20.0 mm where rates were 3.6% (95% CI: 2.0 to 6.3%). The likelihood of PCR in eyes with axial length <20.0 mm was 1.88 times higher than those of ≥20.0 mm (P=0.0373)., Conclusion: Rates of ocular comorbidities vary by axial length. PCR rates in eyes with very short or long axial lengths were lower than expected.
- Published
- 2015
- Full Text
- View/download PDF
41. A Proposed Minimum Standard Set of Outcome Measures for Cataract Surgery.
- Author
-
Mahmud I, Kelley T, Stowell C, Haripriya A, Boman A, Kossler I, Morlet N, Pershing S, Pesudovs K, Goh PP, Sparrow JM, and Lundström M
- Subjects
- Delphi Technique, Humans, Intraoperative Complications, Postoperative Complications, Quality Assurance, Health Care, Refraction, Ocular, Registries, Risk Factors, Standard of Care, Visual Acuity physiology, Cataract Extraction standards, Lens Implantation, Intraocular, Ophthalmology standards, Outcome Assessment, Health Care standards, Quality Indicators, Health Care
- Abstract
Importance: Aligning outcome measures for cataract surgery, one of the most frequently performed procedures globally, may facilitate international comparisons that can drive improvements in the outcomes most meaningful to patients., Objective: To propose a minimum standard set of outcome measures for cataract surgery that enables global comparisons., Design, Setting, and Participants: A working group of international experts in cataract outcomes and registries was convened, along with a patient advocate, to agree on a consensus of outcome measures for cataract surgery. In a modified Delphi process, the group met regularly between November 10, 2012, and November 21, 2013, to discuss which outcomes to include in a standard set. Included factors were based on extant literature, existing registries, and the experience of group members. Similarly, a series of consensus discussions were held to determine a set of risk factors to be gathered for each patient. The final shortlist was compiled into a standard set. Analysis was performed from November 22, 2013, to April 5, 2014., Main Outcomes and Measures: Development of a recommended standard set encompassing preoperative metrics including patient risk factors, intraoperative factors including surgical complications, and postoperative cataract surgery outcomes., Results: The recommended standard set encompasses all patients treated for cataracts by 1 of 4 surgical approaches (phacoemulsification, sutured manual extracapsular cataract extraction, sutureless manual extracapsular cataract extraction, or intracapsular cataract extraction). The recommended metrics to be recorded preoperatively include demographics, ocular history and comorbidities, preoperative visual acuity, and patient-reported visual function. The recommended outcomes were split into intraoperative and postoperative metrics. Intraoperative outcomes include capsule-related problems, dislocation of lens nucleus fragments into the vitreous, and other complications. Postoperative outcomes include visual acuity, refractive error, patient-reported visual function, and early and late complications of surgery. The suggested follow-up for collection of postoperative outcomes is up to 3 months., Conclusions and Relevance: A minimum standard set of outcome measures for cataract surgery is important for meaningful comparison across contexts. The proposed data set is a compromise between all useful data and the practicalities of data collection.
- Published
- 2015
- Full Text
- View/download PDF
42. Statistical Analysis for Studies of Intraocular Lens Formula Accuracy.
- Author
-
Aristodemou P, Knox Cartwright NE, Sparrow JM, and Johnston RL
- Subjects
- Humans, Biometry, Clinical Protocols, Lenses, Intraocular, Optics and Photonics
- Published
- 2015
- Full Text
- View/download PDF
43. THE ROYAL COLLEGE OF OPHTHALMOLOGISTS' NATIONAL OPHTHALMOLOGY DATABASE STUDY OF VITREORETINAL SURGERY: Report 4, Epiretinal Membrane.
- Author
-
Jackson TL, Donachie PH, Williamson TH, Sparrow JM, and Johnston RL
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anesthesia, General statistics & numerical data, Epiretinal Membrane physiopathology, Female, Humans, Intraoperative Complications, Male, Middle Aged, Prospective Studies, Retinal Detachment epidemiology, Retinal Detachment surgery, Retinal Perforations epidemiology, Retinal Perforations surgery, Societies, Medical organization & administration, United Kingdom epidemiology, Visual Acuity physiology, Databases, Factual statistics & numerical data, Epiretinal Membrane surgery, Medical Audit, Ophthalmology organization & administration, Vitreoretinal Surgery statistics & numerical data
- Abstract
Purpose: To report pragmatic outcomes from a database study of epiretinal membrane surgery., Methods: Prospective anonymized clinical audit data from electronic medical records were pooled over 10 years into a national database, from 1,131 primary epiretinal membrane operations, by 69 surgeons, in 16 U.K. vitreoretinal units., Results: The median age of 1,131 patients was 71.6 years. A pars plana vitrectomy and epiretinal membrane peel were combined with internal limiting membrane peel in 17.0% of operations, and cataract surgery in 49.9%. Use of general anesthesia declined from 94.1% in 2001 to 28.9% in 2010. One or more intraoperative complication occurred in 9.8% (8.1% excluding cataract surgery complications). The median preoperative logarithm of the minimum angle of resolution (logMAR) visual acuity improved from 0.60 to 0.30 (Snellen 20/80-20/40) after a median follow-up of 7.0 months; 41.7% of eyes improved ≥0.30 logMAR units (approximately 2 Snellen's lines). The percentages of eyes undergoing subsequent surgery were 3.3%, 1.0%, 0.4%, and 0.8% for epiretinal membrane, retinal detachment, macular hole, and other vitreoretinal indications, respectively. Excluding pseudophakic eyes, 51.7%, 73.2%, and 76.2% of eyes underwent cataract surgery within 1 year, 2 year, and 3 years respectively., Conclusion: These results may help vitreoretinal surgeons to benchmark their surgical outcomes, and patients to assess the risks and benefits of surgery.
- Published
- 2015
- Full Text
- View/download PDF
44. The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 1, visual outcomes and complications.
- Author
-
Day AC, Donachie PH, Sparrow JM, and Johnston RL
- Subjects
- Aged, Aged, 80 and over, Databases, Factual, Female, Humans, Intraoperative Complications, Male, Middle Aged, Outcome Assessment, Health Care, Posterior Capsular Rupture, Ocular etiology, Postoperative Complications, Prospective Studies, United Kingdom, Visual Acuity, Vitreous Detachment etiology, Cataract Extraction adverse effects, Cataract Extraction statistics & numerical data
- Abstract
Aims: To describe the outcomes of cataract surgery in the United Kingdom., Methods: Anonymised data on 180 114 eyes from 127 685 patients undergoing cataract surgery between August 2006 and November 2010 were collected prospectively from 28 sites. Outcome measures included intraoperative and postoperative complication rates, and preoperative and postoperative visual acuities., Results: Median age at first eye surgery was 77.1 years, 36.9% cases had ocular co-pathology and 41.0% patients underwent cataract surgery on both eyes. Preoperative visual acuity was 0.30 logMAR or better in 32.0% first eyes and 47.7% second eyes. Postoperative best-measured visual acuity was 0.00 and 0.30 logMAR or better in 50.8 and 94.6% eyes without ocular co-pathology, and 32.5 and 79.9% in eyes with co-pathology. For eyes without co-pathology, postoperative uncorrected distance visual acuity was 0.00 and 0.30 logMAR or better in 27.3 and 80.9% eyes. Posterior capsule rupture or vitreous loss or both occurred in 1.95% cases, and was associated with a 42 times higher risk of retinal detachment surgery within 3 months and an eight times higher risk of endophthalmitis., Conclusion: These results provide updated data for the benchmarking of cataract surgery. Visual outcomes, and the rate of posterior capsule rupture or vitreous loss or both appear stable over the past decade.
- Published
- 2015
- Full Text
- View/download PDF
45. United Kingdom National Ophthalmology Database study of vitreoretinal surgery: report 3, retinal detachment.
- Author
-
Jackson TL, Donachie PH, Sallam A, Sparrow JM, and Johnston RL
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Air, Cataract Extraction, Child, Child, Preschool, Electronic Health Records, Endotamponade, Female, Fluorocarbons administration & dosage, Humans, Infant, Intraoperative Complications, Male, Middle Aged, Prospective Studies, Reoperation, Retinal Detachment physiopathology, Silicone Oils administration & dosage, United Kingdom, Visual Acuity physiology, Young Adult, Databases, Factual statistics & numerical data, National Health Programs statistics & numerical data, Ophthalmology statistics & numerical data, Retinal Detachment surgery, Vitreoretinal Surgery statistics & numerical data
- Abstract
Purpose: To describe rhegmatogenous retinal detachment (RD) surgery., Design: National Ophthalmology Database study., Participants: A total of 3403 eyes from 3321 patients undergoing primary RD surgery., Methods: Participating centers prospectively collected clinical data using a single electronic medical record system, with automatic extraction of anonymized data to a national database, from 2002 to 2010., Main Outcome Measures: Description of the primary procedures performed, intraoperative complication rate, and proportion of eyes undergoing subsequent RD or cataract surgery. We undertook an exploratory analysis of change in visual acuity (VA) using the data available., Results: Of 3403 operations, 2693 (79.1%) were pars plana vitrectomy (PPV), 413 (12.1%) were retinopexy with a scleral buckle (SB), and 297 (8.7%) were PPV with an SB (PPV-SB). For PPV and PPV-SB, 18.8% were with hexafluoroethane, 12.1% were with perfluoropropane, 43.1% were with sulfahexafluoride, 1.8% were with air, 17.9% were with silicone oil, and 10.7% were with cataract surgery. Within 1 year of vitrectomy, 52.1% of phakic eyes had undergone cataract surgery. For all RD operations combined (and excluding cataract surgery complications), 5.1% had 1 or more intraoperative complication, 13.0% underwent further RD surgery, and 8.3% had silicone oil in situ at last review. The RD reoperation rate was 13.3%, 12.3%, and 14.5% for PPV, SB, and PPV-SB, respectively. For 961 eyes with a baseline and final VA measurement, the median presenting logarithm of the minimum angle of resolution VA improved from 1.0 to 0.5 (20/200-20/63) after a median follow-up of 0.6 years., Conclusions: These results may help vitreoretinal surgeons to benchmark their intraoperative complication rate and reoperation rate and to compare their surgical techniques with their peers'. They suggest that the benefits of RD surgery greatly outweigh the risks., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
46. United Kingdom National Ophthalmology Database Study: Diabetic Retinopathy; Report 1: prevalence of centre-involving diabetic macular oedema and other grades of maculopathy and retinopathy in hospital eye services.
- Author
-
Keenan TD, Johnston RL, Donachie PH, Sparrow JM, Stratton IM, and Scanlon P
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Databases, Factual, Diabetic Retinopathy classification, Electronic Health Records, Female, Hospital Departments, Humans, Infant, Macular Edema classification, Male, Middle Aged, Prevalence, United Kingdom epidemiology, Young Adult, Diabetic Retinopathy epidemiology, Macular Edema epidemiology, Ophthalmology statistics & numerical data, State Medicine statistics & numerical data
- Abstract
Aims: To report estimates of the prevalence of diabetic retinopathy (DR) and maculopathy grades for a large cohort of patients managed by the UK hospital eye service (HES)., Methods: Anonymised data were extracted from 30 UK NHS hospital trusts using a single ophthalmic electronic medical record (EMR) for the period from April 2000 to November 2010 to create the National Ophthalmology Database (NOD). From 2007, the EMR facilitated capture of a nationally agreed-upon standardised data set (DR Structured Assessment) relating to the presence or absence of clinical signs of DR and maculopathy. An algorithm in the software automatically calculated the Early Treatment of Diabetic Retinopathy Study grades of retinopathy and maculopathy., Results: Between 2007 and 2010, 307,538 patients had data on the NOD, with 76,127 (24.8%) patients having been recorded as having diabetes. The proportion of patients with diabetes who had a structured assessment increased from 50.7% (2007) to 86.8% (2010). In each NHS year, 12.6-20.6% of eyes with structured assessments had no DR; 59.6-67.3% had non-proliferative DR; and 18.3-20.9% had active or regressed proliferative DR. Clinically significant macular oedema was present in 15.8-18.1% of eyes, and in 8.7-10.0% of eyes, this involved the central macula., Conclusion: This study provides contemporary estimates of the prevalence of retinopathy and maculopathy grades in a large cohort of patients with diabetes managed by the UK HES. Centre-involving diabetic macular oedema, potentially amenable to anti-VEGF therapy, is present in the eyes of almost 10% of these patients. This information is useful for clinicians, health-care economists, and commissioners involved in planning and delivering diabetic eye services.
- Published
- 2013
- Full Text
- View/download PDF
47. United Kingdom National Ophthalmology Database Study of Vitreoretinal Surgery: report 1; case mix, complications, and cataract.
- Author
-
Jackson TL, Donachie PH, Sparrow JM, and Johnston RL
- Subjects
- Aged, Female, Humans, Incidence, Male, Middle Aged, Postoperative Complications, Prospective Studies, United Kingdom epidemiology, Cataract Extraction statistics & numerical data, Intraoperative Complications epidemiology, Intraoperative Complications etiology, Vitrectomy adverse effects, Vitrectomy methods
- Abstract
Aim: To report the vitreoretinal (VR) surgical case mix in the United Kingdom, the intraoperative complication rate of pars plana vitrectomy (PPV), and the incidence of post-vitrectomy cataract extraction., Methods: Participating hospitals prospectively collected ophthalmic data using a single electronic medical record system, with automatic extraction of anonymised data to a national database. This study included the subset of 11618 VR operations undertaken on 9619 eyes, of 8741 patients, over 8 years, from 27 sites. Surgical data included the indication for surgery, all procedure elements, and whether or not an intraoperative complication occurred. Post-vitrectomy cataract data were also analysed. The main outcome measures were a description of the indications for surgery, intraoperative PPV complication rate, and percentage of eyes undergoing post-vitrectomy cataract surgery (PVCS)., Results: The most common indications for VR intervention were retinal breaks and rhegmatogenous retinal detachment (48.5%), macular hole (9.8%), epiretinal membrane (9.6%), and diabetic eye disease (7.3%). Overall, 7.8% of PPVs had at least one intraoperative complication-the most common were iatrogenic retinal breaks (3.2%), and lens touch (1.2-1.6% of phakic eyes). PVCS occurred in 50.2, 68.7, and 74.0% of eyes at 1, 2, and 3 years, respectively., Conclusion: VR surgery is undertaken for a wide range of conditions, but a small number of diagnoses encompass the majority of cases. Intraoperative PPV complications are not uncommon, and post-vitrectomy cataract is to be expected in most phakic eyes.
- Published
- 2013
- Full Text
- View/download PDF
48. United Kingdom National Ophthalmology Database study of vitreoretinal surgery: report 2, macular hole.
- Author
-
Jackson TL, Donachie PHJ, Sparrow JM, and Johnston RL
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Electronic Health Records, Endotamponade, Female, Fluorocarbons administration & dosage, Humans, Intraoperative Complications, Male, Middle Aged, Postoperative Complications, Prospective Studies, Reoperation, Retinal Perforations epidemiology, Sulfur Hexafluoride administration & dosage, United Kingdom epidemiology, Visual Acuity physiology, Vitrectomy, Young Adult, Databases, Factual statistics & numerical data, Ophthalmology statistics & numerical data, Retinal Perforations surgery, Vitreoretinal Surgery statistics & numerical data
- Abstract
Purpose: To study macular hole (MH) surgery in terms of baseline demographics, intraoperative complications, post-vitrectomy cataract, reoperation, and visual outcome., Design: National Ophthalmology Database study., Participants: A total of 1078 eyes from 1045 patients undergoing primary MH surgery., Methods: Participating centers prospectively collected clinical data using a single electronic medical record (EMR) system, with automatic extraction of anonymized data to a national database, over 8 years. The following data were extracted for eyes undergoing MH surgery: demographics, procedure elements, intraoperative complications, visual acuity (VA), and further surgery., Main Outcome Measures: Description of the primary procedures performed, intraoperative complication rate, change in VA, proportion of eyes undergoing subsequent surgery for persisting MH, cataract, or retinal detachment., Results: The median age was 70.3 years, with a 2.2:1 female preponderance. All operations included a pars plana vitrectomy (PPV)-41.1% with hexafluoroethane (C2F6), 25.6% with perfluoropropane (C3F8), 24.5% with sulfahexafluoride (SF6), 2.2% with air, and 0.4% with silicone oil. A PPV was combined with internal limiting membrane (ILM) peel in 94.1% and cataract surgery in 40.5%. One or more intraoperative complications occurred in 12.4%. The median presenting logarithm of the minimum angle of resolution (logMAR) VA improved from 0.80 to 0.50 after a median follow-up of 0.6 years; 57.8% of eyes improved ≥0.30 logMAR units (∼2 Snellen lines). The choice of gas tamponade did not significantly influence the visual outcome, but eyes undergoing ILM peel were significantly more likely to gain ≥0.30 logMAR units, as were eyes with poor presenting VA. Subsequently, 4.2% of eyes underwent repeat surgery for MH and 2.4% for retinal detachment, and, excluding pseudophakic eyes, 64.6% underwent cataract surgery within 1 year., Conclusions: This study provides pooled, anonymized data on the demographics, complications, and visual outcome of MH surgery. This may enable vitreoretinal surgeons to benchmark their case-mix and outcomes, and facilitate risk-benefit and cost-benefit analyses., (Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
49. How nice is NICE?
- Author
-
Sparrow JM
- Subjects
- Humans, United Kingdom, Advisory Committees, Eye Diseases therapy, Government Agencies, Health Services Accessibility organization & administration, Ophthalmology, Practice Guidelines as Topic, Technology Assessment, Biomedical
- Published
- 2013
- Full Text
- View/download PDF
50. First eye prediction error improves second eye refractive outcome results in 2129 patients after bilateral sequential cataract surgery.
- Author
-
Aristodemou P, Knox Cartwright NE, Sparrow JM, and Johnston RL
- Subjects
- Humans, Lens Implantation, Intraocular, Models, Theoretical, Prospective Studies, Diagnostic Errors, Functional Laterality physiology, Lenses, Intraocular, Phacoemulsification, Refraction, Ocular physiology, Refractive Errors diagnosis, Visual Acuity physiology
- Abstract
Objective: To define theoretical correction factors for second-eye intraocular lens (IOL) power adjustment based on first eye refractive prediction error (PE)., Design: Database study., Participants: We included 2129 patients who underwent bilateral sequential phacoemulsification cataract surgery with the same IOL model., Methods: Retrospectively calculated PEs (Hoffer Q, Holladay 1, SRK/T) were analyzed for association between paired eyes, examining the effect of interocular differences in axial length (AL) and corneal power. A range of correction factors (CF) derived from the first eye PE were applied to the second eye PE using optimized and non-optimized IOL constants (IOLCs)., Main Outcome Measures: Second eye mean absolute error (MAE)., Results: Prediction errors of paired eyes were correlated. Interocular corneal power differences exceeding 0.60 diopters (D) were associated with a weaker correlation but interocular AL differences did not affect the correlation. When a 50% CF was applied to second eyes of patients with a first eye PE between ±0.50 and ±1.50 D, it improved refractive outcomes from 30%, 56%, and 92% to 42%, 75%, and 96% within ±0.25 D, ±0.50 D and ±1.00 D, respectively, and reduced the MAE from 0.49 to 0.37 D (P<0.0001). For first eye PE below ±0.50 D, a 50% CF reduced the MAE from 0.32 to 0.30 D (P<0.00001). A 50% CF also reduces second eye MAE for eyes with nonoptimized IOLCs., Conclusions: A 50% CF reduces second eye PE when either first eye optimized PE is within ±1.50 D or when nonoptimized IOLCs are used. The correlation is weaker when interocular corneal power differences are >0.60 D., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.