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1. Requirement for, and optimisation of, premium intraocular lenses

Author

Bhogal, Gurpreet

Subjects
617.755
Abstract

Premium intraocular lenses (IOLs) aim to surgically correct astigmatism and presbyopia following cataract extraction, optimising vision and eliminating the need for cataract surgery in later years. It is usual to fully correct astigmatism and to provide visual correction for distance and near when prescribing spectacles and contact lenses, however for correction with the lens implanted during cataract surgery, patients are required to purchase the premium IOLs and pay surgery fees outside the National Health Service in the UK. The benefit of using toric IOLs was thus demonstrated, both in standard visual tests and real-world situations. Orientation of toric IOLs during implantation is critical and the benefit of using conjunctival blood vessels for alignment was shown. The issue of centration of IOLs relative to the pupil was also investigated, showing changes with the amount of dilation and repeat dilation evaluation, which must be considered during surgery to optimize the visual performance of premium IOLs. Presbyopia is a global issue, of growing importance as life expectancy increases, with no real long-term cure. Despite enhanced lifestyles, changes in diet and improved medical care, presbyopia still presents in modern life as a significant visual impairment. The onset of presbyopia was found to vary with risk factors including alcohol consumption, smoking, UV exposure and even weight as well as age. A new technique to make measurement of accommodation more objective and robust was explored, although needs for further design modifications were identified. Due to dysphotopsia and lack of intermediate vision through most multifocal IOL designs, the development of a trifocal IOL was shown to minimize these aspects. The current thesis, therefore, emphasises the challenges of premium IOL surgery and need for refinement for optimum visual outcome in addition to outlining how premium IOLs may provide long-term and successful correction of astigmatism and presbyopia.

Published
2012
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5. Astigmatism and vision:should all astigmatism always be corrected?

Author

Wolffsohn, James S., Bhogal, Gurpreet, and Shah, Sunil

Subjects
genetic structures, eye diseases
Abstract

As technology and medical devices improve, there is much interest in when and how astigmatism should be corrected with refractive surgery. Astigmatism can be corrected by most forms of refractive surgery, such as using excimer lasers algorithms to ablate the cornea to compensate for the magnitude of refractive error in different meridians. Correction of astigmatism at the time of cataract surgery is well developed and can be achieved through incision placement, relaxing incisions and toric intraocular lens (IOL) implantation. This was less of an issue in the past when there was a lower expectation to be spectacle independent after cataract surgery, in which case the residual refractive error, including astigmatism, could be compensated for with spectacle lenses. The issue of whether presurgical astigmatism should be corrected can be considered separately depending on whether a patient has residual accommodation, and the type of refractive surgery under consideration. We have previously reported on the visual impact of full correction of astigmatism, rather than just correcting the mean spherical equivalent. Correction of astigmatism as low as 1.00 dioptres significantly improves objective and subjective measures of functional vision in prepresbyopes at distance and near.

Published
2014

6. Visual outcomes and subjective experience after bilateral implantation of a new diffractive trifocal intraocular lens

Author

Sheppard, Amy, Shah, Sunil, Bhatt, Uday, Bhogal, Gurpreet, and Wolffsohn, James

Subjects
genetic structures, sense organs, eye diseases
Abstract

Purpose - To assess clinical outcomes and subjective experience after bilateral implantation of a diffractive trifocal intraocular lens (IOL). Setting - Midland Eye Institute, Solihull, United Kingdom. Design - Cohort study. Methods - Patients had bilateral implantation of Finevision trifocal IOLs. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), and manifest refraction were measured 2 months postoperatively. Defocus curves were assessed under photopic and mesopic conditions over a range of +1.50 to -4.00 diopters (D) in 0.50 D steps. Contrast sensitivity function was assessed under photopic conditions. Halometry was used to measure the angular size of monocular and binocular photopic scotomas arising from a glare source. Patient satisfaction with uncorrected near vision was assessed using the Near Activity Visual Questionnaire (NAVQ). Results - The mean monocular CDVA was 0.08 logMAR ± 0.08 (SD) and the mean binocular CDVA, 0.06 ± 0.08 logMAR. Defocus curve testing showed an extended range of clear vision from +1.00 to -2.50 D defocus, with a significant difference in acuity between photopic conditions and mesopic conditions at -1.50 D defocus only. Photopic contrast sensitivity was significantly better binocularly than monocularly at all spatial frequencies. Halometry showed a glare scotoma of a mean size similar to that in previous studies of multifocal and accommodating IOLs; there were no subjective complaints of dysphotopsia. The mean NAVQ Rasch score for satisfaction with near vision was 15.9 ± 10.7 logits. Conclusions - The trifocal IOL implanted binocularly produced good distance visual acuity and near and intermediate visual function. Patients were very satisfied with their uncorrected near vision.

Published
2013

8. Multifocal intraocular lens differentiation using defocus curves

Author

Buckhurst, Phillip J., Wolffsohn, James S., Naroo, Shehzad A., Davies, Leon N., Bhogal, Gurpreet K., Kipioti, Athina, Shah, Sunil, Buckhurst, Phillip J., Wolffsohn, James S., Naroo, Shehzad A., Davies, Leon N., Bhogal, Gurpreet K., Kipioti, Athina, and Shah, Sunil

Abstract

Purpose: To determine the most appropriate analysis technique for the differentiation of multifocal intraocular lens (MIOL) designs using defocus curve assessment of visual capability.Methods:Four groups of fifteen subjects were implanted bilaterally with either monofocal intraocular lenses, refractive MIOLs, diffractive MIOLs, or a combination of refractive and diffractive MIOLs. Defocus curves between -5.0D and +1.5D were evaluated using an absolute and relative depth-of-focus method, the direct comparison method and a new 'Area-of-focus' metric. The results were correlated with a subjective perception of near and intermediate vision. Results:Neither depth-of-focus method of analysis were sensitive enough to differentiate between MIOL groups (p>0.05). The direct comparison method indicated that the refractive MIOL group performed better at +1.00, -1.00 and -1.50 D and worse at -3.00, -3.50, -4.00 and -5.00D compared to the diffractive MIOL group (p

Published
2012

10. Are Early Warning Scores documented accurately and correctly by nurses: A Critical Review

Author

Bhogal, Gurpreet Kaur and Bhogal, Gurpreet Kaur

Abstract

Aim: The aim of this dissertation is to critically review the literature surrounding the accuracy of nurses’ documentation of the EWS. This critical review aims to examine the quality and methods of the current research on EWS documentation and whether these can be enhanced in any way. Background: Assessment tools, such as the EWS, implemented in nursing care are vital due to their preventative nature. Instruments such as the EWS are viewed as highly integral in assessing, planning and implementing the correct care for a patient. However, policies and research identify that nurses do not comply with the guidelines and protocol for the use of the EWS. The relationship between increased rates of mortality and the number of physiological abnormalities is directly proportional, therefore, if abnormal observations are detected and reported by the nurse then mortality rates within the hospital setting should be reduced. The EWS plays a great role in this; however, it needs to be implemented correctly by the nurse to aid patient care and safety in a significant manner. Method: A critical review was employed to meet the aim of this dissertation. This method was chosen instead of a systematic review as systematic reviews process large quantities of existing research however, the topic of EWS is quite under researched; therefore a critical review seemed more appropriate. Results: EWS documentation is poor and often incomplete. The RR is especially neglected when recording vital signs. Although training programmes are put into place they do not always result in changing staff behaviour. Conclusion: Overall, EWS documentation needs to improve. It is recommended that more qualitative research be conducted, teamed with theoretical frameworks, to find out why documentation is poor. Also, to give research more merit RCTs would be useful too.

11. Are Early Warning Scores documented accurately and correctly by nurses: A Critical Review

Author

Bhogal, Gurpreet Kaur and Bhogal, Gurpreet Kaur

Abstract

Aim: The aim of this dissertation is to critically review the literature surrounding the accuracy of nurses’ documentation of the EWS. This critical review aims to examine the quality and methods of the current research on EWS documentation and whether these can be enhanced in any way. Background: Assessment tools, such as the EWS, implemented in nursing care are vital due to their preventative nature. Instruments such as the EWS are viewed as highly integral in assessing, planning and implementing the correct care for a patient. However, policies and research identify that nurses do not comply with the guidelines and protocol for the use of the EWS. The relationship between increased rates of mortality and the number of physiological abnormalities is directly proportional, therefore, if abnormal observations are detected and reported by the nurse then mortality rates within the hospital setting should be reduced. The EWS plays a great role in this; however, it needs to be implemented correctly by the nurse to aid patient care and safety in a significant manner. Method: A critical review was employed to meet the aim of this dissertation. This method was chosen instead of a systematic review as systematic reviews process large quantities of existing research however, the topic of EWS is quite under researched; therefore a critical review seemed more appropriate. Results: EWS documentation is poor and often incomplete. The RR is especially neglected when recording vital signs. Although training programmes are put into place they do not always result in changing staff behaviour. Conclusion: Overall, EWS documentation needs to improve. It is recommended that more qualitative research be conducted, teamed with theoretical frameworks, to find out why documentation is poor. Also, to give research more merit RCTs would be useful too.

12. Are Early Warning Scores documented accurately and correctly by nurses: A Critical Review

Author

Bhogal, Gurpreet Kaur and Bhogal, Gurpreet Kaur

Abstract

Aim: The aim of this dissertation is to critically review the literature surrounding the accuracy of nurses’ documentation of the EWS. This critical review aims to examine the quality and methods of the current research on EWS documentation and whether these can be enhanced in any way. Background: Assessment tools, such as the EWS, implemented in nursing care are vital due to their preventative nature. Instruments such as the EWS are viewed as highly integral in assessing, planning and implementing the correct care for a patient. However, policies and research identify that nurses do not comply with the guidelines and protocol for the use of the EWS. The relationship between increased rates of mortality and the number of physiological abnormalities is directly proportional, therefore, if abnormal observations are detected and reported by the nurse then mortality rates within the hospital setting should be reduced. The EWS plays a great role in this; however, it needs to be implemented correctly by the nurse to aid patient care and safety in a significant manner. Method: A critical review was employed to meet the aim of this dissertation. This method was chosen instead of a systematic review as systematic reviews process large quantities of existing research however, the topic of EWS is quite under researched; therefore a critical review seemed more appropriate. Results: EWS documentation is poor and often incomplete. The RR is especially neglected when recording vital signs. Although training programmes are put into place they do not always result in changing staff behaviour. Conclusion: Overall, EWS documentation needs to improve. It is recommended that more qualitative research be conducted, teamed with theoretical frameworks, to find out why documentation is poor. Also, to give research more merit RCTs would be useful too.

13. Are Early Warning Scores documented accurately and correctly by nurses: A Critical Review

Author

Bhogal, Gurpreet Kaur and Bhogal, Gurpreet Kaur

Abstract

Aim: The aim of this dissertation is to critically review the literature surrounding the accuracy of nurses’ documentation of the EWS. This critical review aims to examine the quality and methods of the current research on EWS documentation and whether these can be enhanced in any way. Background: Assessment tools, such as the EWS, implemented in nursing care are vital due to their preventative nature. Instruments such as the EWS are viewed as highly integral in assessing, planning and implementing the correct care for a patient. However, policies and research identify that nurses do not comply with the guidelines and protocol for the use of the EWS. The relationship between increased rates of mortality and the number of physiological abnormalities is directly proportional, therefore, if abnormal observations are detected and reported by the nurse then mortality rates within the hospital setting should be reduced. The EWS plays a great role in this; however, it needs to be implemented correctly by the nurse to aid patient care and safety in a significant manner. Method: A critical review was employed to meet the aim of this dissertation. This method was chosen instead of a systematic review as systematic reviews process large quantities of existing research however, the topic of EWS is quite under researched; therefore a critical review seemed more appropriate. Results: EWS documentation is poor and often incomplete. The RR is especially neglected when recording vital signs. Although training programmes are put into place they do not always result in changing staff behaviour. Conclusion: Overall, EWS documentation needs to improve. It is recommended that more qualitative research be conducted, teamed with theoretical frameworks, to find out why documentation is poor. Also, to give research more merit RCTs would be useful too.

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