ABSTRACT
Fuchs' endothelial corneal dystrophy (FECD) is progressive corneal endothelium dysfunction, characterised by corneal oedema, and potential blindness if left untreated. Keratoplasty is the only definitive treatment to restore vision in FECD, with different surgical techniques being described. The corneal transplant has been described as the most commonly performed and most successful allogenic transplant globally; therefore, it is crucial to dissect it further since a large proportion of the population worldwide is likely to be impacted. We feel that an updated literature review is both very relevant and necessary at present and aim to amalgamate more recent data on the topic (including meta-analyses, systematic reviews, and randomised control trials (RCTs), among others). We acknowledge that the paucity of reliable data limits progress for FECD and that there are existing ethical complexities in performing prospective trials on patients. Traditionally, the surgery for FECD was limited to penetrating keratoplasty (PK), yet recent developments have introduced more advanced procedures and adapted the existing ones, to provide treatment specific to the disease-affected corneal layers. The questions we will address encompass: how does the severity of FECD govern the treatment options available, what are the differences between PK and types of endothelial keratoplasty (EK), what are the expected clinical outcomes of each of these operations, what are the potential concerns with the idealistic descemetorhexis surgery, and what do we envisage for times to come? Besides this, novel minimally-invasive pharmacological techniques are now being trialled, such as Rho kinase (ROCK) inhibition and cultured endothelial cells (CECs), which may drastically improve the dependence on corneal donors. We examine and critically appraise the literature to explore the understanding of FECD, and the treatment options that exist: historically, currently, and those anticipated for the future.
ABSTRACT
Introduction Computed tomography (CT) scanning has become a fundamental aspect of many diagnostic pathways and therapeutic procedures. However, it is not without risk. Many patients are unaware of the exposure to ionising radiation that is involved with undergoing a CT scan, as well as the associated increase in cancer risk with cumulative exposure. Controversy over which clinician is responsible for advising a patient regarding CT risk often means that patients are left uninformed and unaware. Those who choose to seek further guidance online do so with the risk of encountering poor quality, difficult-to-read medical text, which may leave them even more confused or misinformed. Aim This study aimed to assess the readability, quality, and accuracy of the information available to patients online regarding CT scans and their associated risks. Method An internet search of 180 websites was collated using three search terms, each entered into three search engines. The terms used were 'CT Risk', 'CT Harm', and 'Dangers of a CT Scan'. Unique websites generated were assessed for readability using four readability formulae: The Flesh-Kincaid Grade Level, the Flesch Reading Ease Score, the Gunning Fog Index, and the Simple Measure of Gobbledygook (SMOG) Index. The text on each website was also evaluated for quality and accuracy using the Discern tool. Mean readability scores were calculated and compared against the defined standard required for the information intended for the general public. A two-tailed t-test was also carried out to assess statistical significance. Results Of the 180 websites collated, 77 were unique. 76.62% of websites (59/77) met the readability target for the Flesch-Kincaid Grade Level, and 66.23% (51/77) met the target for the Gunning Fog Index, which was for text to be readable at the Grade 8 level (or by children aged 13-14). 59.74% (46/77) met the target for the SMOG Index, which for healthcare information, was defined as Grade 6 Level, or children aged 11-12. Only 11.69% of websites (9/77) met the target for the Flesch Reading Ease score. 55.84% of websites satisfied the pre-defined standard for three out of four readability criteria, however, only 11.69% satisfied all four criteria, limited by the scores obtained by the Flesch Reading Ease formula. The websites generated a mean Discern score of 3.58, meaning the average quality of the information was deemed to be 'fair', with no serious shortcomings. Conclusion More than 50% of websites satisfied three readability criteria simultaneously. However, there is still scope for improvement, both in terms of enhancing the readability of the remaining websites, and also ensuring that all websites review the proportion of polysyllabic words in the text, which is the emphasis of the Flesh Reading Ease Score. In addition, physicians and radiologists have a responsibility to inform patients of the risks associated with CT scans, and to direct them to supplementary good-quality information and resources.
