Biomedical subjects

C A McCarty

Publications and source records attributed to C A McCarty.

117 records · Page 7Linked to original sources

PubMedDate not supplied

Description and measurement of handicap caused by vision impairment.

To develop an instrument to describe and quantify handicap caused by vision impairment an item pool was derived from focus groups and from a review of vision-related quality-of-life questionnaires. Only items related to handicap were included and grouped into five subscales. The 76-item 'Impact of Vision Impairment' was administered to 95 people who were vision impaired. Content validity was established by consultation with professionals and with people with impaired vision. Forty-six items remained after the elimination of those found to be irrelevant and others with inter-item correlation coefficients of > or = 0.7. Univariate and multivariate analyses revealed an association between visual acuity and type and degree of handicap on subscales, except emotional reaction to vision loss, which is related to cause of vision impairment. The instrument is responsive to the level of vision loss and discriminates the different performances of people with different causes of vision loss.

Activities of Daily Living↗

PubMedDate not supplied

Unemployment and under-employment in adults with vision impairment: The RVIB Employment Survey.

PURPOSE: The purpose of this study was to describe the labour force status in Victorian adults with vision impairment and any factors associated with unemployment and under-employment. METHODS: Participants were recruited in 1997. A telephone interview was conducted by trained interviewers. RESULTS: A total of 250 people participated. They ranged in age from 19 to 59 years (mean 40.7 years) and 119 (48%) were male. Thirty-nine (16%) people regarded themselves to be totally blind. Nearly everyone (n=241, 96%) had been employed at some time during their lifetime; however, only 149 (60%) were currently employed. The current rate of participation in the labour force was 73.3% (95% CL, 67.8%, 78.8%) and the current unemployment rate was 18.2% (95% CL, 12.6%, 23.9%). The current rate of under-employment was 16.0% (95% CL, 10.7%, 21.4%). A total of 126 (50%) people had used services that help with employment at some stage; this was not significantly associated with current employment status (P > 0.10). The factors significantly associated with unemployment in multivariate analyses were a self-report of eyesight limiting time available for work or other activities (OR=3.02; 95% CL, 1.56, 5.85) and currently looking for work (OR=5.92; 95% CL, 2.94, 11.9); never having worked was of borderline significance (OR=5.26; 95% CL, 0.85, 32.7) as a result of the small numbers of people surveyed. The only factor significantly associated with under-employment was self-employment (OR=5.46; 95% CL, 1.95, 15.3). DISCUSSION: Results from this study reveal that visual function is not a predictor of labour force status. The relatively low use of specialty employment services and the rather high rate of discouraged job seekers suggest that the employment outcomes of people who use these services should be investigated further, and that attention should be directed at improving retention of employment in people with vision impairment.

Adolescent↗

PubMedDate not supplied

Awareness of eye donation in an urban population in India.

PURPOSE: Awareness of eye donation and willingness to pledge eyes for donation was assessed in the urban population of Hyderabad, India, where corneal blindness is a significant problem. METHODS: A total of 2522 subjects of all ages, representative of the Hyderabad population, participated in the Andhra Pradesh Eye Disease Study. Subjects >15 years old were interviewed regarding awareness of eye donation and willingness to pledge eyes for donation. RESULTS: Age-gender-adjusted prevalence of awareness of eye donation was 73.8% (95% CI: 66.5-81.0%) but only 1.9% (95% CI: 0.16-3.66%) had pledged eyes. With multivariate analysis, significantly less awareness of eye donation was found in illiterate subjects (OR 0.1; 95% CI: 0.1-0.14), subjects > or =70 years old (OR 0.3; 95% CI: 0.2-0.6), subjects of lower socio-economic status (OR 0.4; 95% CI: 0.3-0.6), females (OR 0.6; 95% CI: 0.5-0.8) and Muslims (OR 0.7; 95% CI: 0.6-0.9). Media was the major source of information about eye donation. Of those aware of eye donation, 44.9% were willing to pledge eyes. Willingness to pledge eyes for donation was significantly lower in Muslims (OR 0.18; 95% CI: 0.13-0.24) than in Hindus and in subjects > or =60years old (OR 0.3; 95% CI: 0.2-0.5). CONCLUSIONS: These data show that although only a few had pledged eyes there is enough potential in this population for obtaining many more corneas for transplantation. The information about distribution and demographic associations of awareness and willingness for eye donation could help in developing strategies to increase procurement of corneas for dealing with corneal blindness.

Adolescent↗

PubMedDate not supplied

Compliance with recommendations from a screening programme for diabetic retinopathy.

METHODS: General practitioner compliance with recommendations for patient follow-up after participation in a screening programme for diabetic retinopathy was assessed. Six months after screening with non-mydriatic retinal photography in four areas of Victoria, the genera practitioner of each participant was surveyed if the participant reported no examination for diabetic retinopathy in the past 2 years and if the results of the screening indicated the need for further assessment. RESULTS: Overall, 208 of 253 (82%) completed questionnaires were analysed. A total of 123 (59%) patients were referred by their doctors for further assessment and 97 (79%) of those referred were reported to have complied with the referral. Of the 85 (41%) patients who were not referred for further assessment, 31 (36%) were reported by their doctors to be already under regular review by an ophthalmologist. CONCLUSIONS: Compliance with genera practitioner referrals suggests that this screening programme was effective and a useful means by which to remind general practitioners of the importance of regular eye examinations for people with diabetes.

Australia↗

PubMedDate not supplied

Vision impairment and handicap: The RVIB Employment Survey. The Steering Committee for the RVIB Employment Survey.

PURPOSE: The purpose of this study was to examine the association between type of vision impairment and disability and the handicap or impact of vision loss on functioning. METHODS: Participants were interviewed for the Royal Victorian Institute for the Blind Employment Survey, and asked to self-report whether totally blind or not (vision impaired). Causes of visual impairment were also reported. Eyesight was rated on a scale from 0 (completely blind) to 10 (best possible eyesight). Difficulty with mobility, personal care, household activities, work and hobbies and social interactions were also rated. Participants with vision impairment also rated their level of disability in reading and seeing other people's reactions using the same scale. RESULTS: Of the 250 participants, 39 self-reported total blindness. Participants with vision impairment experienced greater levels of difficulty in almost all areas than people who self-reported total blindness. People with vision impairment due to glaucoma and macular degeneration reported significantly more difficulty with reading newspapers, while there was a borderline significant relationship between difficulty with seeing people's reactions and macular degeneration. CONCLUSIONS: In summary, we found that difficulty associated with everyday tasks was greater than might be expected from self-report of vision. This study confirms the need for visual function tools to supplement the use of objective visual acuity measurements in people with vision impairment.

Activities of Daily Living↗

PubMedDate not supplied

Cost-effectiveness of digital cataract assessment.

PURPOSE: The aim of this study was to compare costs of digital photograph grading with that of film-based, human grading of the lens in epidemiological studies involving cataract assessment. METHODS: Cost-effectiveness was measured by establishing the number of participants with ungradeable images and incorporating these lost data into the overall cost per participant for each study. RESULTS: The digital grading system cost was A$105000 with operating costs of $2.81 per participant, with 99.4% effectiveness. The film-based, human grading set-up costs were $43000 with operating costs of $18.49 per participant and 90% effectiveness. After examining 3500 people the use of the digital equipment becomes cost-beneficial. CONCLUSIONS: The high costs of setting up a digital cataract grading system are offset by the low running costs, less ungradeable images and greater accuracy over the duration of a large scale ophthalmic epidemiological study.

Cataract↗

PubMedDate not supplied

Assessment of subjective pain following photorefractive keratectomy. Melbourne Excimer Laser Group.

BACKGROUND: Although researchers have reported that postoperative pain in patients undergoing excimer laser photorefractive keratectomy (PRK) surgery is common in the first 24 hours after excimer surgery, factors associated with increased postoperative pain have not been reported. The purpose of this study was to prospectively document self-reported pain following excimer laser surgery and explore associated factors. METHODS: Consecutive patients undergoing excimer laser photorefractive keratectomy (PRK) surgery to correct myopia and/or myopic astigmatism were asked to prospectively grade, on a four-point scale, the amount of pain they were experiencing immediately after treatment and again 2, 4, 8, 24, and 48 hours after surgery. They were also asked to record the type and dose of all medication taken during that time period. RESULTS: Pain questionnaires were returned by 62 patients (72%), ranging in age from 20 to 54 years. The mean self-reported pain overall peaked 24 hours after treatment. Amount of myopia and prior excimer experience were not related to use of analgesia or self-reported pain (both p > 0.10). Patients who had three additional topical drops of indomethacin postoperatively reported significantly less pain 24 hours after treatment (t = 5.95, p = 0.0001). CONCLUSION: These results have implications for the education of patients about the likely course of healing after PRK. A course of five drops of topical indomethacin should be evaluated with a randomized clinical trial to assess efficacy in inhibiting ocular pain after PRK.

Administration, Topical↗

PubMedDate not supplied

Effect of variations in surgical technique and patient management on outcomes of photorefractive keratectomy. Melbourne Excimer Laser Group.

PURPOSE: To describe variation in surgical and patient management and to assess their effect on 12-month outcomes of photorefractive keratectomy (PRK). METHODS: The following variations in surgical/patient management related to PRK were observed and assessed: treatment based on cycloplegic refraction, administration of anesthesia, marking of visual axis, diameter of zone marker, method of epithelial removal, use of intraoperative artificial tears, type of fixation during surgery, replacement of epithelium after surgery, use of a bandage contact lens or two pressure patches, and use of topical nonsteroidal antiinflammatory drugs after surgery. The outcomes assessed were spherical equivalent manifest refraction, spectacle-corrected visual acuity and uncorrected visual acuity. RESULTS: One year clinical outcomes were assessed prospectively for a group of 645 eyes that underwent PRK or photoastigmatic keratectomy. Spherical equivalent refraction and uncorrected visual acuity were better with decreasing amounts of preoperative myopia (both F > 30.0, both p = 0.0001). Although some surgical variations produced statistically significantly better uncorrected visual acuity on univariate analyses, none of the variations in the techniques assessed were found to be statistically significantly related to clinical outcomes after controlling for preoperative spherical equivalent refraction (all F < 2.5, all p > 0.10). None of the surgical variations were associated with loss of spectacle-corrected visual acuity (all p > 0.10). CONCLUSION: Clinical outcomes of PRK were not significantly affected by minor variations in clinical and surgical practice.

Adult↗

PubMedDate not supplied

Prevalence of myopia in adults: implications for refractive surgeons.

BACKGROUND: We reviewed the research on the prevalence of myopia in the adult population to compare the refractive distribution of patients being treated with excimer laser photorefractive keratectomy to correct myopia, and assess the potential market for excimer laser surgery. METHODS: All published reports of myopia prevalence in adults were reviewed, as well as the prevalence in the Melbourne Visual Impairment Project and the distribution of refractive errors treated by the Melbourne Excimer Laser Group in 1994. RESULTS: A large population-based study of people aged 4 to 74 years in the U.S. showed that 43% had low myopia (less than -5.00 diopters (D)), 3.2% had high myopia (-5.01 to -10.00 D), and 0.2% had extreme myopia (more than -10.00 D). In Asian populations these proportions may be much higher and in African and Pacific island groups, much lower. In the Melbourne Visual Impairment Project, we found the prevalence of low myopia was 21%, high myopia 2%, and extreme myopia 0.3%. A single excimer laser has operated for 3 years in Melbourne. Of those treated, 45% had low myopia, 42% high myopia, and 13% extreme myopia. Compared to low myopes, high myopes were ten times (OR: 9.8; Confidence interval: 6.69 to 12.91) more likely to have excimer laser treatment and extreme myopes were 16 times (OR: 16.40; Confidence interval: 12.53 to 20.27) more likely. CONCLUSIONS: Although there are many more people with lower amounts of myopia in the population and the clinical results have been more predictable after one procedure in this group, the perceived benefits of excimer laser treatment may be greater for those with higher amounts of myopia, thus influencing their decision to undergo excimer laser surgery to correct their myopia. There is clearly a large market potential for excimer laser surgery in people with low myopia.

Adolescent↗