British and Irish Orthoptic Journal最新文献

Aims: To survey orthoptists' confidence in communicating with patients with communication impairments and to investigate resources orthoptists are currently using to aid assessment and management and to explore future resources that may be beneficial.

Methods and procedures: Practicing orthoptists (n = 63; median age range: 31-35 years old) completed an online survey with quantitative and qualitative questions which investigated approaches to adult and paediatric patients with communication impairments and any communication tools used. Analysis of quantitative survey responses was conducted using IBM SPSS v27. Content analysis of qualitative responses was done.

Outcomes and results: Simple communication strategies (e.g., eye contact and body language, repeating/rephrasing sentences) were commonly used with both adult and paediatric patients while more complex strategies (e.g., electronic visual aids, writing key words/concepts) were rarely used. Usage of communication strategies was not affected by length of work experience, workplace clinical speciality or training during their clinical degree or after graduation (p < 0.05). Most participants (71.2%) reported being unaware of resources available for orthoptists to assist in the assessment and management of patients with communication impairments.

Conclusions and implications: Orthoptists have adopted some communication strategies to improve their interactions with patients with communication impairments, despite limited resources. With proper resources, such as training in supportive communication techniques, they can provide optimal patient care, making it essential to identify what kind of resources would be most appropriate.

Aim: An audit of the effectiveness of amblyopia treatment in the Newcastle Eye Centre (NEC) to determine how current visual acuity (VA) outcomes compare to those found in the 2011-12 audit.

Methods: A retrospective database review. VA outcomes of patients who had undergone treatment for anisometropic, strabismic and mixed amblyopia; discharged between 31.08.2016 - 01.09.19, were compared with VA outcomes found in the previous audit. The previous audit reviewed patients commencing amblyopia treatment during 1.1.11-31.12.12.An unpaired T-test was used to assess if results were statistically significantly different to those found previously. Proportion of visual change from commencement to completion of treatment was calculated. The duration of episode from first visit to discharge, adverse events and percentage of patients who achieved acceptable visual outcomes following only six to eight weeks of occlusion, were also analysed.

Results: Between 31.8.16 and 01.09.19, 1,100 patients were discharged, of which 174 had completed amblyopia treatment and fit the inclusion criteria for the audit. Results show no statistically significant difference between current and previous VA outcomes for each type of amblyopia. The majority of patients (60%) achieve a VA outcome of ≤0.250 (logMAR) in the amblyopic eye. This is comparable to the previous audit where 59% of patients achieved a VA outcome of ≤0.250. Most patients still achieve a level of VA which is equal or almost equal to the fellow eye following amblyopia treatment. Treatment is still completed within a two-year period for the majority of patients (62%). There was only one adverse event and this related to atropine occlusion. Only 18 out of the 174 (10%) patients showed that occlusion could be discontinued following just six to eight weeks of treatment.

Conclusions: The treatment of amblyopia in the NEC is as successful as found in the previous audit and the current amblyopia treatment protocol remains effective. Only 10% of patients achieved the appropriate VA for amblyopia treatment to be ceased on their first return visit. This indicates that the follow-up length for patients undergoing amblyopia treatment could be extended beyond six to eight weeks without causing a detriment to VA outcome.

Purpose: Determining the correct power and orientation of prism to be prescribed for patients with symptomatic, oblique-angle strabismus can be challenging and confusing, prone more to clinician gestalt than science or methodology. The author shares a simplified, approach not previously described in the scientific literature that utilizes commercially available equipment and freely available on-line prism calculators for choosing the correct Press-On™ prism power, positioning the prism correctly on the spectacle lens, and ultimately determining the correct prism prescription to be incorporated into the patient's spectacles.

Purpose: The conversion of ocular myasthenia gravis (OMG) to generalised myasthenia gravis (GMG) is reported to differ depending on the presence of generalisation risk factors (Mazzoli et al. 2018). Thymic pathology has been recognised as a potential risk factor for generalisation in the literature (Teo et al. 2017). Thymoma and thymic hyperplasia have yet to be examined as a risk factor for generalisation of OMG independently of other risk factors in the literature. Thus, the purpose of this review is to examine the literature to identify whether thymoma and thymic hyperplasia do increase the risk of OMG progressing to GMG.

Methods: A literature search was carried out which employed a systematic approach. The search was undertaken using the following academic libraries: MEDLINE, Embase and Starplus. The search was limited to publications between the years 2001 to 2021. The search yielded 82 studies, which after the screening of titles and abstracts, left 62 studies for further analysis against the inclusion and exclusion criteria.

Results: The review found thymoma to be associated with an increased risk of GMG development. However, there was a scarce amount of literature which investigated thymic hyperplasia. Therefore, a firm conclusion could not be made with regards to thymic hyperplasia and the risk of GMG development.

Conclusions: This review provides evidence for the consideration of thymectomy early after thymomatous OMG diagnosis to prevent GMG conversion. As the review did not collect enough evidence to support the influence of thymic hyperplasia on OMG conversion, further research is required.

Background: This healthcare quality improvement report focussed on the effectiveness of an orthoptic-led inpatient vision screening service at Nottingham University Hospitals for older adults admitted with a fragility hip fracture. The service was developed in response to national guidance, which recommended a multifactorial assessment, including a vision assessment for older adults presenting following a fall.

Method: Vision screening was carried out by orthoptists on eligible patients ≥65 years of age admitted to the trauma and orthopaedic wards with a hip fracture. Retrospective data for patients screened between 2015-2019 were analysed, including: patient demographics; screening eligibility and outcome; ophthalmology referrals made; ophthalmology appointment attendance; and outcome.

Results: Of the 3321 patients admitted with a hip fracture between 2015-2019, 2033 (61%) were eligible for vision screening and 1532 (75%) of these were screened. Furthermore, 784 (51%) of the patients screened had an ocular abnormality requiring an ophthalmology referral, or a sight test at an optician. Only 144 of the 383 (38%) who required an ophthalmology referral via the GP were successfully referred, and only 107 of the 186 (58%) patients who were given appointments attended them. Additionally, 98 of 107 had pathology, with cataracts the most common finding (51%), and 61 of 98 (62%) patients had treatable vision impairment.

Conclusions: We found a large proportion of fragility hip fracture patients with impaired vision, much of which was treatable and could be detected effectively with orthoptic-led bedside screening. The most common eye problem in those referred to ophthalmology was cataracts. An internal referral pathway to ophthalmology is proposed. There is a need to investigate reasons for disengagement with eye care services in this population.

Aim: To investigate the changes in near accommodative facility and response time in young adults following computer work of 30 minutes and 1 hour in duration.

Methods: A total of 50 young adults (37 females, 13 males) with mean age of 20.68 ± 1.33 years were included in this experimental study. Monocular near accommodative facility was measured using ±2.00 Dioptre Sphere (DS) flipper at 40 cm using the N6 (the smallest print size that can be read by an individual with normal visual acuity) target before and after two reading tasks. Both pre- and post-task measurements were video recorded using a smart phone and the number of cycles per minute, positive response time (time taken to stimulate accommodation), and negative response time (time taken to relax accommodation) were calculated from the video recording. Data were analysed using SPSS Version 22.0.

Results: Out of the 50 participants, 29 were emmetropes (Mean SER: 0.16 ± 0.29 D), and 21 were myopes (Mean SER: -1.89 ± 1.16 D). The mean pre-task accommodative facility was 6.79 ± 3.52 cycles per minute, and the post-task accommodative facility was 6.25 ± 3.65 cycles per minute (p = 0.10) for the 30-minutes task and 5.76 ± 3.89 cycles per minute (p = 0.01) for 1-hour task. The mean pre-task positive response time was 2.87 ± 1.55 seconds, and the post-task positive response times for 30 minutes and 1 hour were 2.86 ± 1.67 seconds (p = 0.88) and 2.98 ± 2.33 seconds (p = 0.42), respectively. The mean pre-task negative response time was 8.77 ± 8.83 seconds, and the post-task negative response times for 30 minutes and 1 hour task were 11.83 ± 14.28 seconds (p = 0.16) and 14.72 ± 17.32 seconds (p = 0.03), respectively.

Conclusion: Monocular near accommodative facility was significantly reduced, and negative response time was delayed following 1 hour of computer work.

Background: Positive fusional vergence (PFV) is vital in maintaining fusion in critical and continuous near tasks such as reading or performing digital screen tasks. This study investigated how PFV changed under various lighting conditions.

Methods: This cross-sectional study recruited 34 participants aged between 21 and 25 years, with best corrected visual acuity (BCVA) 0.0 logMAR and insignificant refractive error. Three different illuminations-low illumination (50 lux), medium lighting (100 lux), and high illumination (150 lux)-were used to examine the ocular parameters PFV (blur, break, and recovery points), contrast sensitivity and pupil diameter.

Results: Pupil diameter changed significantly in different room illuminations (p = 0.00). There was no significant difference in contrast sensitivity across the three levels of room illumination (p = 0.368). Mean PFV (SD) (blur) was 14.5 (2.5) in 50 lux, 10.2 (2.2) in 100 lux, and 8.2 (2.1) in 150 lux. Under 50, 100 and 150 lux, respectively, the mean PFV (SD) (break) values were 16.7 (2.4), 13.4 (1.8), and 10.8 (2.2), and the mean PFV (SD) (recovery) values were 13.3 (2.1), 10.7 (2.1), and 7.5 (2.7). With increased illumination levels, PFV blur, break, and recovery values were significantly lower (p < 0.001).

Conclusions: PFV values were significantly higher in lower illumination. Clinicians should be aware that room illumination affected the PFV values measured.

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Aim: To report the outcomes of the natural progression and ophthalmic treatment of patients reviewed in a tertiary hospital trust with unilateral or bilateral internuclear ophthalmoplegia.

Method: A retrospective case note analysis was performed and 33 patients diagnosed with unilateral or bilateral internuclear ophthalmoplegia (INO) were identified. The diagnosis, aetiology, presence of diplopia, ophthalmic management options and progression were recorded and analysed. This included both conservative and surgical management.

Results: The most common aetiologies of INO within this cohort were stroke/ischaemic (69.7%) and multiple sclerosis (MS) (30.3%). Unilateral INO was more prevalent than bilateral INO, with 20 cases (60.6%) compared to 13 cases (39.4%), respectively. A higher proportion of unilateral INO were attributed to stroke (90%) whilst a higher proportion of bilateral INO were attributed to MS (61.5%). The most prescribed management at primary assessment was occlusion (45.5%) and prisms (24.2%). Some patients required no orthoptic intervention (30.3%). Two patients had surgical management of strabismus secondary to bilateral INO.

Conclusion: Occlusion was the most common form of management for symptomatic relief of diplopia. Patients who presented at the first visit with no symptoms were unlikely to need any orthoptic intervention. Of the two patients who went on to require surgical intervention, restoration of binocular single vision (BSV) was achieved post-operatively with the use of a Fresnel prism. However, the differences in both surgical technique and number of surgeries required make this difficult to generalise. Additional research is needed to further explore the surgical management of INO.

Background: The Sheffield Virtual Adult Strabismus service was already well established and was put to real-time trial during the COVID-19 pandemic. We describe a multi-disciplinary adaptation to offer a safe and effective service delivery. We evaluate the efficacy of a virtual strabismus service during the pandemic to meet clinical demand, streamline patient care, balance care delivery and optimise medical input.

Methods: Prospective data analysis from the virtual strabismus clinics dated from January 2015 to November 2021. All information was captured at first consultation with comprehensive specialist Orthoptic assessment and imaging; then reviewed by a strabismus consultant for clinical outcome. Management was discussed virtually with patients by the consultant.

Results: Pre-COVID (January 2015-March 2020), 1,068 appointments were offered. During COVID (July 2020-November 2021), 442 appointments were offered. Clinical capacity increased to meet demand. Within two months of service re-opening, first appointment mean waiting time reduced below 18 weeks. During COVID, 24.6% of patients were listed for procedures after first visit. Face-to-face medical follow up for non-surgical cases reduced from 47.7% to 16.3%.

Conclusion: Virtual strabismus services offer flexible, safe and effective ways to meet fluctuating referral patterns and maximise limited time and resources. Orthoptists are uniquely essential and highly valued keyworkers to conservatively manage non-surgical strabismus. Utilising the skillsets of Allied Health Professionals (AHPs) across the NHS is crucial to sustain ongoing clinical demand and patient care.