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Counselling for people with sight loss in the UK
It is estimated that about 40% of UK voluntary organisations for people with sight loss provide professional counseling or ‘informal support’, such as peer support groups, telephone helplines and befriending. Nyman et al assessed the evidence for effectiveness of professional counseling services for people with acquired sight loss. Of the 28 counselling services, 14 had not been evaluated, 11 had collected data that would need to be validated, and 3 provided evaluation reports. One report found that 100% of clients on completion of face-to-face counselling had reliably and significantly improved emotional well-being, including a 41% reduction in mild risk of suicide. The authors conclude that there is need to evaluate emotional support services for their effectiveness. See page 385
Determination of treatment for granular corneal dystrophy using FD-OCT
Kim et al evaluated the use of Fourier-domain optical coherence tomography (FD-OCT) in the selection and planning of surgical procedures to treat 6 patients with granular corneal dystrophy type 2. The RTVue-100 FD-OCT revealed the depth of the deposits precisely, allowing the determination of the appropriate depth of PTK (phototherapeutic keratectomy) and the appropriate selection of lamellar versus penetrating keratoplasty. In each case, visually significant opacities were adequately removed. See page 341
Telemedical diagnosis of ROP
Williams et al assessed accuracy of telemedical diagnosis of retinopathy of prematurity (ROP) by trained non-expert graders compared with expert graders. Eye examinations from 67 consecutive infants were captured using wide-angle retinal photography (RetCam-II). Non-expert graders attended two 1-hour training sessions on image-based ROP diagnosis. Using a web-based telemedicine system, 14 non-expert and three expert graders provided a diagnosis for each eye. All diagnoses were compared with a reference standard of dilated indirect ophthalmoscopy by an experienced paediatric ophthalmologist. The authors observed that sensitivity and specificity of trained non-experts were lower than that of experts suggesting that development of methods for training non-expert graders may improve telemedical ROP diagnosis. See page 351
Internet use by ophthalmology patients
Narendran et al assessed whether patients and parents of children attending ophthalmology clinics used internet to obtain healthcare information. 495 anonymous questionnaires were returned from 397 patients and 98 parents of children (response rates of 84% and 77%, respectively). 57% of the individuals attending the clinic had internet access and access decreased with age. They also noted that 83% of the patients wanted the clinicians to provide them with links to reputable websites to improve their healthcare knowledge. The findings imply that it would be worthwhile providing a comprehensive list of user-friendly and accurate healthcare website addresses to the patients. See page 378
Ranibizumab for polypoidal choroidal vasculopathy
Kokame et al evaluated the short-term efficacy and safety of monthly intravitreal injections of ranibizumab in patients with active exudation or haemorrhage due to polypoidal choroidal vasculopathy (PCV) in a prospective trial of monthly intravitreal injections of ranibizumab (0.5 mg) in 12 eyes (12 patients). No patient lost ≤15 letters in visual acuity at 6 months. Subretinal fluid decreased in 5/8 eyes and subretinal haemorrhage resolved in 6/6 eyes. The authors conclude that continuous monthly intravitreal ranibizumab stabilises vision in PCV. However, polypoidal lesions are reduced in only 33% of eyes. See page 297
Imaging of the lens capsule with an ultrahigh resolution SD OCT
Kaluzny et al demonstrate the applicability of ultrahigh-speed, ultrahigh-resolution SD OCT to cross-sectional imaging of the capsular bag in vivo. They designed and constructed a prototype femtosecond laser (780 nm) with an axial resolution of 2.3 μm. The quality was sufficient to evaluate the capsular bag in vivo and to estimate its thickness. See page 275
MacuScope macular pigment densitometer
The MacuScope uses a psychophysical technique called heterochromic flicker photometry to measure macular pigment optical density (MPOD). Bartlett et al determined the measurement variability (noise) of the MacuScope in 38 normally sighted participants (age 19 to 46 years). Data were collected by two operators separated by 1 week in order to assess test repeatability and reproducibility. The overall mean MPOD for the cohort was 0.47±0.14. Coefficients were 0.45 and 0.58 for repeatability, and 0.49 and 0.36 for reproducibility. There was a significant negative correlation between MPOD readings and age. See page 328
Infliximab versus ciclosporin in Behcet's disease
Yamada et al compared the efficacy and safety of infliximab versus ciclosporin A (CsA) in refractory uveoretinitis in 122 patients with Behcet disease. The number of acute episodes of uveitis before and after initiation of CsA and infliximab were 3.362.4 and 1.261.2 and 3.162.7 and 0.461.0, respectively (p<0.005). During the 6-month treatment period, improvement of the visual acuity was similar with two therapies. The authors conclude that infliximab is more effective in reducing acute episodes of uveitis in Behcet disease. See page 284
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