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PubMed1993

Evaluation of argon laser treatment of diabetic retinopathy and its diffusion in The Netherlands.

Argon laser treatment of diabetic retinopathy (DR) is the best evaluated case in the field of minimally invasive therapy. A well-organized randomized controlled trial was followed by formal cost-analyses and cost-effectiveness analyses. Laser treatment of DR proved to be cost-effective in a situation where there was no satisfactory treatment previously. Subsequently, screening strategies for retinopathy were developed. Systematic screening for DR in diabetic populations would be cost-saving from a societal perspective. The availability of effective and cost-effective therapy and cost-saving screening strategies for DR warrants active policy making to stimulate the implementation of strategies to control retinopathy in diabetic populations. Such strategies would ideally include both guided diffusion of argon lasers and the organization of screening programs. Data from the Netherlands are used to illustrate the diffusion of argon lasers in health care. After a slow start, argon lasers have diffused widely in the Dutch health care system. This development is complemented by recommendations for screening of the European diabetic population, which were issued in 1991. More active cooperation of all parties involved would benefit in preventing blindness from DR.

Argon↗
PubMed2003

Comparison of measurements of refractive errors between the hand-held Retinomax and on-table autorefractors in cyclopleged and noncyclopleged children.

PURPOSE: To compare the measurement of refractive errors (sphere, cylinder, and axis) between the hand-held Retinomax and on-table Topcon autorefractors in cyclopleged and noncyclopleged young children. The average bias and measurement agreement were assessed. DESIGN: Observational cross-sectional study. METHODS: The study included 114 cyclopleged and 156 noncyclopleged young children. The mean difference between the two methods and the 95% limits of agreement were calculated to evaluate the average bias. Two types of analyses were conducted to assess the degree of agreement. First, the proportion of the absolute mean differences was presented in different ranges ( 1.0 diopters for sphere and cylinder; 0-10, 11-20 and >20 degrees for axis). Second, the paired t test was conducted to evaluate the consistency of two types of measurements. RESULTS: The data by the Retinomax had mild bias (0.59 diopters) toward a lower sphere data under noncycloplegia but no bias under cycloplegia. For cylinder and axis, there was either no bias or clinically acceptable bias (0.02-0.13 diopters for cylinder and 2-7 degrees for axis) regardless of cycloplegia. Besides the sphere data under noncycloplegia, in general 90% of the mean differences of sphere and cylinder were within 0.5 diopters. More than 97% of the difference in axis under cycloplegia and 68% under noncycloplegia were within 20 degrees. After adjusting for mild bias, the paired t test showed very consistent results. CONCLUSIONS: The data by the Retinomax were consistent with those by the Topcon. The Retinomax is a useful instrument to screen refractive errors in young children.

Child↗
PubMedDate not supplied

Issues in the epidemiology and population-based screening of primary angle-closure glaucoma.

Among Caucasians, it is well known that 75-95% of primary glaucoma is due to open-angle glaucoma (POAG), with angle-closure (PACG) comprising only a very small minority of cases. These figures are reversed among other groups such as Asians and Eskimos, where PACG makes up 80-90% of primary glaucoma. Among Eskimos, the prevalence of PACG has been reported as 2-8%, as compared to 0.1% among Caucasians. It appears that a population tendency toward shallow anterior chambers may explain the excess burden of PACG morbidity. Among Asians, the prevalence of PACG is intermediate between Caucasians and Eskimos. Existing biometrical data do not show a clear tendency toward shallower anterior chambers among Asians. PACG may be screened for on a population basis by means of various techniques that estimate axial or limbal anterior chamber depth, measure intraocular pressure, or evaluate the optic disc or visual fields. Demographic information and medical and family history will also be of great importance in screening for PACG in large populations. Groups at increased risk for the disease include women, individuals over 50, first-degree relatives of PACG probands, and hyperopes.

Asia↗
PubMed2005

Use of disposable prism tonometry in routine clinical practice.

AIM: To establish the reliability, efficacy, and safety of disposable prism tonometry and validate its routine use for screening as well as monitoring of glaucoma. METHODOLOGY: Intraocular pressure (IOP) of 400 eyes of 200 consecutive patients who attended the general ophthalmic clinic was checked with both the Goldmann applanation tonometer and a disposable tonometer prism by an experienced examiner after obtaining informed consent. The data were statistically analysed. RESULTS: The mean difference in the IOP between the two types of prisms was 0.1 mmHg (SD+/-1 mmHg). CONCLUSION: Disposable prism tonometry provides a reliable, effective, and safe alternative to Goldmann reusable prism tonometry for routine screening as well as monitoring of glaucoma with the advantages of eliminating the need for chemical disinfection and therefore eliminating the risk of crossinfection.

Cross Infection↗
PubMed1994

[How accurate is video refraction measurement in infants in comparison with skiascopy? How much do the values change within a half a year?].

BACKGROUND: Isotropic photorefraction (Atkinson et al., 1981) is a method used to screen the refraction in infants. The aim of this study is to analyze its limitations as a measuring instrument. MATERIALS AND METHODS: 215 children aged between 5 and 12 months were examined in cycloplegia. The results were subsequently compared (1) to the results of streak retinoscopy also performed at the same time and (2) to photorefraction performed a second time, 6 months later (with 145 children). RESULTS: Spherical refraction: The mean spherical values differed by 0.70 dpt through photorefraction methods, compared to retinoscopy. The standard deviation (SD) was 0.67 dpt. The values of the photorefraction differed therefore in 95% of the children within a range of 2.7 dpt (or +/- 2 SD). Compared to the second photorefractive measurement 6 months later, the average refraction showed a small myopic shift (-0.45 dpt). Astigmatism: The errors of measurement were more pronounced here. Extreme differences of up to 9 dpt were found in single cases. The mean difference, compared to retinoscopy, was 0.73 dpt. The standard deviation (SD) was 0.90 dpt. In 95% of the children, the values of photo-refraction differed therefore by a range of 3.6 dpt (or +/- 2 SD). Compared to the second photorefractive measurement 6 months later, the average refraction showed a mean change of 0.73 dpt. CONCLUSIONS: Our photorefractive measurements showed errors in the range of 1-2 dpt for the spherical refraction, and in the range of 2-3 dpt for astigmatism. In 5% of the children examined, even greater aberrations were found. As long as the aim of photorefraction is restricted to disclosing high refractive errors, this method is judged suitable for the refractive screening of infants. For more precise refraction, and for the prescription of spectacles, we believe that is should be supplemented by a second examination technique, such as retinoscopy or automated refractometry.

Astigmatism↗
PubMed1993

'Correctable undetected visual acuity deficit' in patients aged 65 and over attending an accident and emergency department.

The rate of occurrence of correctable undetected visual acuity deficit (CUVAD) in a population of patients aged 65 and over was investigated, using a pinhole screening method, to compare the sociodemographic and optical eye care habits of patients with or without a functionally significant CUVAD. Of 136 patients 46 (34%) were found to have a functionally significant CUVAD in one or both eyes which was not significantly associated with optician or general practitioner contact, age, sex, social class, living situation, or number of medications. Half the patients with significant CUVAD had not attended for 2 years mainly because of financial considerations. Three quarters attended of their own volition; only one in seven were prompted by opticians' postal invitations. It was concluded that a significant degree of CUVAD could be detected using a simple procedure which can be carried out by general practitioners as part of their general elderly health screen.

Aged↗
PubMedDate not supplied

The multifocal pattern electroretinogram in chloroquine retinopathy.

PURPOSE: Optimal screening for ocular toxicity caused by chloroquine and hydroxychloroquine is still controversial. With the multifocal pattern electroretinogram (mfPERG), a new electrophysiological technique has recently become available to detect early changes of ganglion cells. In this study this new technique is applied to a series of 10 patients seen consecutively receiving long-term chloroquine medication. METHODS: In 10 patients receiving chloroquine medication, clinical examination, Amsler visual field testing and computerized color vision testing were performed. If toxicity was suspected, automated perimetry was carried out. In addition, in all patients conventional pattern electroretinogram (PERG) and mfPERG testing were performed. RESULTS: On clinical examination 8 patients showed no chloroquine-associated maculopathy, while 2 patients did. Of these 2, only 1 reported abnormalities when viewing the Amsler chart, while automated perimetry showed typical, ring-like paracentral scotomas in both affected patients and color vision was significantly abnormal. In the normal patients, 4 of 8 had a mild color vision disturbance, which correlated to age-related macular changes. The amplitudes of the PERG and the central (approximately 10 degrees ) responses of the mfPERG were markedly reduced in chloroquine maculopathy, while the latencies were unchanged. The peripheral rings of mfPERG (ranging to 48 degrees ) were not affected by chloroquine toxicity. Both PERG and mfPERG were less affected by age-related macular changes. CONCLUSIONS: The reduction of PERG and central mfPERG responses in chloroquine maculopathy may help with the early detection of toxicity.

Adult↗
PubMed2003

The polaroid suppression test in a pediatric population with ophthalmologic disorders.

PURPOSE: The Polaroid suppression test (PST) is a new method for early detection of amblyogenic factors by screening for suppression. The apparatus can elicit suppression with the use of Polaroid filters. The aim of the present study was to examine a population of children with known ophthalmologic disorders using the PST to determine the rate of false-negative results of the PST. METHODS: Six hundred four children, varying in age between 3 and 15 years (mean, 7.9) were examined using the PST. Ophthalmologic disorders ranged from strabismus and amblyopia to refractive disorders. RESULTS: Mean testing time for the PST was 43 seconds. The PST could not be administered to 34 children (5.6%); 443 children (73.3%) had abnormal results; and 127 children (22.2%) showed no suppression. The suppression in constant strabismus was detected in almost all cases. The sensitivity for accommodative forms of strabismus was lower, but amblyopia was never missed in these cases. In children with normal eye alignment, only 2.7% with an interocular acuity difference of more than 0.1 logMAR had no suppression. Of all 119 children with clinical defined amblyopia, only 1 (0.8%) did not have suppression. Overall sensitivity of the PST for strabismus and/or abnormal interocular acuity difference was 96.2% and specificity was 41.1%. CONCLUSIONS: The PST has great potential as a visual screening tool in young children. Only few children with amblyogenic factors were missed. Thus, the test can differentiate those children at risk for amblyopia from normally sighted children. Because specificity is lower, all children showing suppression with the PST in a screening situation should have further examination by the health care worker before being referred to the ophthalmologist.

Accommodation, Ocular↗
PubMed1996

Screening for diabetic retinopathy in South Africa with 60 degrees retinal colour photography.

OBJECTIVES: Comparison of 60 degrees mydriatic retinal photography, in screening for diabetic retinopathy, with diabetes clinic doctors, formal ophthalmological assessment, and with one or two 45 degrees fields. DESIGN: Consecutive subjects screened by clinicians and photography, and selected eyes evaluated by an ophthalmologist. Randomized photographs assessed through one or two 45 degrees fields (by masking the slides), and at 60 degrees. SETTING: The first 663 patients attending for routine clinic visits and screened for retinopathy. MAIN OUTCOME MEASURES: The relative diagnostic sensitivity of screening methods, the utility of screening one eye only, and the costs of photographic screening. RESULTS: Compared to an ophthalmologist's assessment, retinal photography had a sensitivity of 93% and a specificity of 89% for any retinopathy, and 100 and 75%, respectively, for severe retinopathy. Photography detected 28% more retinopathy (16% severe) than the clinicians. Compared to a 60 degrees field, one 45 degrees field missed 31%, and 2 x 45 degrees fields 11% of retinopathy. Of 57 patients with retinopathy meeting referral criteria, 31 pairs of eyes had substantially discordant scores. The cost of diagnosis in a patient requiring referral to ophthalmologist was about US $37.00. CONCLUSIONS: 60 degrees retinal photography compares well with an ophthalmologists screening, and is better than clinical and one to two 45 degrees field assessments. Both retinae should be screened. This method is cost-effective in our hands.

Diabetic Retinopathy↗
PubMed1991

[Glaucoma screening--justified or not justified?].

In explaining the damages of primary open-angle glaucoma, the elevated eye pressure was assumed to be the central causative factor. But epidemiological research found high proportions of the following clinical entities: only elevated pressure without further damages (called ocular hypertension), and only glaucomatous damages without high pressure (called normal- or low-pressure glaucoma). These facts made the pressure-theory doubtful, and therefore it had to be modified. Some authors, though, doubt the general validity of the pressure-theory, and postulate other models for the etiology of glaucomatous damages. According to current knowledge, for the diagnosis and screening of primary open angle glaucoma, emphasis should be put rather on the visual fields and the appearance of the optic disc, while pressure measurements supply further clues.

Adult↗
PubMed2006

Longitudinal glaucoma screening for siblings of patients with primary open angle glaucoma: the Nottingham Family Glaucoma Screening Study.

AIMS: To assess the prevalence and cumulative incidence of open angle glaucoma (OAG) in a cohort group of siblings of OAG probands. METHODS: Between 1994 and 2003, a group of siblings of OAG probands underwent both initial and follow up standardised ophthalmic examinations. Siblings were classified as "definite glaucoma" (primary OAG (POAG) and normal tension glaucoma (NTG)), "glaucoma suspects" (NTG suspects or ocular hypertension (OHT)), and normal. The prevalence and cumulative incidence of OAG over the follow up interval were calculated. RESULTS: At the initial study, 271 siblings (mean age 63.6 years; female to male ratio 1.2) from 156 probands were examined. 32 (11.8%) were classified as definite glaucoma and 15 (5.5%) as suspects. In the follow up study, 157 of the 224 "normal" siblings from the initial study were examined (mean interval from initial study 7.0 (SD 1.0) years). 11 (7%) were classified as definite glaucoma and 30 (19.1%) as suspects. There were significant trends of increasing prevalence and incidence of OAG with age and a lifetime risk estimated at approximately 20% by age 70. CONCLUSION: Siblings of glaucoma patients have an increased risk of developing glaucoma and the risk increases with age. An effective and repeated screening programme should be considered for this high risk group.

Age Distribution↗
PubMed1998

Impact of diabetic retinopathy screening on a British district population: case detection and blindness prevention in an evidence-based model.

OBJECTIVES: To quantify case detection and blindness prevention attainable through screening for diabetic retinopathy in a district population. DESIGN: Literature review including a pooled estimate of screening test sensitivity, and quantitative modelling, including sensitivity analyses. SETTING AND PATIENTS: The diabetic population of a typical district health authority or health board. MAIN RESULTS: Evidence suggests that in a British general practice based diabetic population, prevalence of retinopathy requiring treatment would be between 1% and 6%; annual incidence of blindness among diabetics with retinopathy requiring treatment would be between 6% and 9%; sensitivity of screening tests in detecting retinopathy requiring treatment would be between 50% and 88%; and treatment could prevent 77% of expected cases of blindness. Of those screened, about 4% would be correctly detected as requiring treatment during an initial screening round, but this yield could decrease to about 1% in subsequent annual screening rounds. Of those treated, about 6% would be prevented from going blind within a year of treatment and 34% within 10 years of treatment. CONCLUSIONS: Screening and early treatment of diabetic retinopathy can prevent substantial disability. The effectiveness and efficiency of screening could be enhanced by improving the performance of current tests or increasing use of mydriatic retinal photography, and by increasing uptake, particularly among diabetics at greatest risk.

Blindness↗
PubMed1998

An extraordinary role for village community development workers in diagnosing blindness in the community.

OBJECTIVE: To determine the reliability of village community development workers in screening for blindness in the community and to suggest an extraordinary role for these cadres. DESIGN: Diagnostic study. SETTING: Chivi District, Zimbabwe. SUBJECTS: A simple random sample of 148 out of 886 people selected from notification forms. MAIN OUTCOME MEASURE: Sensitivity, specificity and predictive values. RESULTS: The screening method employed was found to have a sensitivity of 93% (95% CI), specificity of 32% (95% CI) and a predictive value for a positive result of 75%. CONCLUSION: The use of village community development workers to screen for blindness in the community has proved to be a reliable alternative when there is shortage of both ophthalmic trained personnel and funds.

Blindness↗
PubMed1993

TNO stereopsis test as an aid to the prevention of amblyopia.

In this investigation, carried out under a Youth Health Care postgraduate course in Nijmegen, the stereopsis of a school population of 730 children, aged 4-18 years, was recorded and clinically evaluated. Stereopsis was measured using the TNO test, a random-dot stereo test especially designed for the early detection of amblyopia. The main aims of this study were to establish the validity of the TNO test as a screening test for amblyopia, obtain information about the variability and age dependence of stereopsis, and to evaluate the efficacy of amblyopia prevention. The most important findings can be summarized as follows: 1. All amblyopes are detected by the TNO test's recommended referral criterion of 240 sec arc (binocular threshold parallax in sec arc). 2. The red-green anaglyphs used in the test do not pose problems for individuals with a colour vision deficiency. 3. The ability to discriminate depth improves by a factor of two over the age interval 4-12 years. 4. A stereoacuity of < or = 120 sec arc is a good predictor of normal or correctable normal vision, and may therefore help in evaluating the often incomplete results of eye tests of young children. 5. Where there is an increased perinatal risk, there is a greater chance of disturbed binocular vision. 6. It is estimated that 75% of amblyopes remain amblyopic, possibly because of delayed detection; 60% of the amblyopes in the population examined were not identified before the age of 5 years.

Adolescent↗
PubMed1997

Mortality in diabetic patients participating in an ophthalmological control and screening programme.

The aim of this follow-up study has been to assess retinopathy and change of treatment to insulin therapy as risk factors for mortality in diabetic patients participating in a control and screening programme for retinopathy. A total of 3220 diabetic patients, 483 with an age at diagnosis <30 years, and 2737 with an age at diagnosis > or = 30 years, were included. Retinopathy was graded on fundus photographs using the Wisconsin Scale, and the visual acuity was assessed. The average HbA1c value was calculated for each patient for the previous 8 years to estimate long-term glycaemic control. Mortality data were obtained from death certificates. Two hundred and sixty-three diabetic patients (8.2%) died during the mean follow-up time of 3.4 years, 13 (2.7%) of those with younger-onset (<30 years) and 250 (9.1%) of those with older-onset (> or = 30 years) diabetes. Of them, 148 (56.3%) died from cardiovascular and 23 (8.7%) from cerebrovascular disorders. After adjusting for differences in age and sex, more severe retinopathy and the use of antihypertensive drugs were associated with a decreased overall survival rate as well as an increased mortality from cardiovascular and cerebrovascular diseases. A statistically significant association between HbA1c values in the highest quartile, i.e. > or =8.4%, and cardiovascular and all cause mortality did not remain when retinopathy was entered into the multivariate analyses. Duration of diabetes, but not change of treatment to insulin therapy, was associated with higher cardiovascular mortality in patients whose diabetes was diagnosed after the age of 30 years. We conclude that severe retinopathy, use of antihypertensive drugs, and poor glycaemic control predicted death from cardiovascular disease in diabetic patients participating in an ophthalmological screening programme.

Adolescent↗
PubMed1996

Tackling amblyopia in human infants.

Amblyopia can possibly be avoided if it is detected early and treated appropriately. It remains to be decided whether the general population should be screened or whether a subpopulation of infants likely to develop this pathology can be isolated. A population study using the odds ratio was performed on a group of unselected infants (n = 2143) aged 5-15 months who attended a surveillance programme. Results show that a family history of visual defect has a 'protective' effect on individual infants, most probably because more of these infants are brought in for a check-up at an early age on the parents' initiative. The risk factor with the highest predisposition for amblyopia was found to be anisometropia. These results indicate the necessity for screening of refraction and resolution defects in the whole population. The French health authorities have recently decided to provide for a visual assessment visit to all infants at the age of 9 months.

Age Factors↗
PubMed1994

Automated tritan discrimination sensitivity: a new clinical technique for the effective screening of severe diabetic retinopathy.

We have developed and extensively assessed an automated chromatic discrimination test which can be used to screen effectively a diabetic population for sight threatening diabetic eye disease. Equiluminant, sinusoidal, low spatial frequency, chromatic gratings are produced along a tritan confusion axis under computer software control on a high resolution CRT. The correct position of the tritan axis in colour space was calibrated using subjects whilst they were transiently tritanopic. The minimum amplitude about a neutral "grey point" along the tritan confusion axis at which a subject can just distinguish a grating is found using a double staircase reversal algorithm. This measure is taken as the Tritan Discrimination Sensitivity and it is this that we use to flag those diabetics with severe diabetic retinopathy. This computerised tritan discrimination test is quick, non-invasive, easy to operate, inexpensive and reliable. The test-retest reliability coefficient (rho) is 0.92. The tritan discrimination test effectively identifies those diabetics who have or are most at risk of developing severe diabetic retinopathy. The sensitivity of the test for the detection of maculopathy, ischaemic retinopathy (pre-proliferative), and proliferative retinopathy is 97%, 65%, and 93%, respectively. The corrected specificity of the test is 83%. We conclude that the tritan discrimination test has potential for use as a valuable screening tool for the early detection and treatment of severe diabetic retinopathy.

Adolescent↗
PubMed1990

Costing a community based screening programme for the detection of glaucoma.

The cost of detecting a case of glaucoma in a community based screening programme was calculated using data from a pilot study on a population aged 50 and over. The cost per screen was estimated at 3.35 pounds with a total cost of 311 pounds per case detected. These estimates include the cost of both the algorithmically based screening programme and the hospital assessment of true and false positives. These costs are considered to compare favourably with the potential costs incurred by paying optometrists to screen high risk groups whilst providing the opportunity to detect over twice the number of cases of occult glaucoma.

Community Health Services↗