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Synopsis Advanced glaucoma is associated with sight loss. This within-trial economic evaluation compares medical and surgical management strategies. At 2 years, medication appears more cost-effective though longitudinal outcomes are an important subject in future research. Background/aims Open angle glaucoma (OAG) is a progressive optic neuropathy. Approximately 25% of newly diagnosed patients with OAG present with advanced disease in at least one eye. The vision loss associated with OAG can lead to significant impacts on vision, quality of life and health care resources. The Treatment of Advanced Glaucoma Study is a randomised controlled trial comparing the effectiveness of primary surgical and medical management for newly diagnosed advanced patients with OAG. An economic evaluation was carried out to understand the costs and benefits of each strategy. Methods A cost utility analysis was carried out from a National Health Service perspective over a 2-year time horizon inclusive of patient costs. The primary outcome was patient health-related quality of life measured by the EQ-5D-5L, Health Utilities Index 3 (HUI3) and Glaucoma Utility Index (GUI). Results were expressed as incremental cost per QALY gained. Results Trabeculectomy was associated with higher costs and greater effect, the EQ-5D-5L results have an incremental cost per QALY of £45,456. The likelihood of surgery being cost-effective at a £20, 000, £30,000 and £50,000 QALY threshold is 0%, 12% and 56%, respectively. The results for the HUI3, GUI and inclusion of patient costs do not change the conclusions of the study. Conclusion This is the first study to evaluate management strategies for those presenting with advanced glaucoma. At a 2-year time horizon, medication is the more cost-effective approach for managing glaucoma. Future research can focus on the costs and benefits of the treatments over a longer time horizon. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Previous studies have shown an association between cataracts and the use of systemic steroid drugs in the treatment of diseases such as arthritis. A cataract is the progressive, usually age-related degeneration of the lens of the eye, resulting in loss of transparency with blurred, distorted vision. There is reason to suspect that renal (kidney) failure may contribute to the development of cataracts. Data pooled from other studies indicate that there is a 51 percent incidence of posterior subcapsular cataract (PSC) in renal transplant patients. A study of 55 kidney transplant patients was undertaken to describe the clinical features of cataracts that developed and compare them with age-related cataracts. Patients were grouped by treatment protocol; these protocols have evolved over at least a 10-year period. The protocols included both high- and low-dose steroids (prednisolone and methylprednisolone) as well as the immunosuppressive drugs cyclosporin and azathioprine. The average age of patients was 41 years; patients older than 56 were excluded from the study in order to avoid the confounding factor of age-related cataract. Follow-up averaged 4.4 years. PSC developed in 12 of the 55 kidney transplant recipients (22 percent). The thickness of the lens in these patients was significantly greater than in a control group, which included 99 patients with clear lenses and no eye disease, diabetes or kidney failure. The morphology of the PSC of patients with kidney transplants differed from age-related PSC, with kidney patients showing no narrowing of the anterior clear zone, which is seen in age-related PSC. There was no relationship found between increase in size of the lens and time elapsed since kidney transplant. It appears that the stimulus for cataract development occurs mainly in the time immediately surrounding the transplant surgery, and it is suggested that this type of PSC be termed 'recovering' PSC, since the cataract-causing factor is no longer active. It is concluded that maintenance doses of steroids and immunosuppressive drugs are probably not among the causes of cataracts. (Consumer Summary produced by Reliance Medical Information, Inc.)

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. [ABSTRACT FROM AUTHOR]