Mental health among Ebola survivors in Liberia, Sierra Leone and Guinea: results from a cross-sectional study.

OBJECTIVES: To describe the prevalence and correlates of depression and anxiety among adult Ebola virus disease (EVD) survivors in Liberia, Sierra Leone and Guinea. DESIGN: Cross-sectional. SETTING: One-on-one surveys were conducted in EVD-affected communities in Liberia, Sierra Leone and Guinea in early 2018. PARTICIPANTS: 1495 adult EVD survivors (726 male, 769 female). PRIMARY AND SECONDARY OUTCOME MEASURES: Patient Health Questionnaire-9 (PHQ-9) depression scores and Generalised Anxiety Disorder-7 (GAD-7) scores. RESULTS: Prevalence and severity of depression and anxiety varied across the three countries. Sierra Leone had the highest prevalence of depression, with 22.0% of participants meeting the criteria for a tentative diagnosis of depression, compared with 20.2% in Liberia and 13.0% in Guinea. Sierra Leone also showed the highest prevalence of anxiety, with 10.7% of participants meeting criteria for generalized anxiety disorder (GAD-7 score ≥10), compared with 9.9% in Liberia and 4.2% in Guinea. Between one-third and one-half of respondents reported little interest or pleasure in doing things in the previous 2 weeks (range: 47.0% in Liberia to 37.6% in Sierra Leone), and more than 1 in 10 respondents reported ideation of self-harm or suicide (range: 19.4% in Sierra Leone to 10.4% in Guinea). Higher depression and anxiety scores were statistically significantly associated with each other and with experiences of health facility-based stigma in all three countries. Other associations between mental health scores and respondent characteristics varied across countries. CONCLUSIONS: Our results indicate that both depression and anxiety are common among EVD survivors in Liberia, Sierra Leone and Guinea, but that there is country-level heterogeneity in prevalence, severity and correlates of these conditions. All three countries should work to make mental health services available for survivors, and governments and organisations should consider the intersection between EVD-related stigma and mental health when designing programmes and training healthcare providers.

Postoperative changes in intraocular pressure and corneal biomechanical metrics Laser in situ keratomileusis versus laser-assisted subepithelial keratectomy.

PURPOSE: To compare intraocular pressure (IOP) and corneal biomechanical metric changes after myopic laser in situ keratomileusis and laser-assisted subepithelial keratectomy (LASEK). SETTING: Private practice, St. Louis, Missouri, USA. METHODS: The IOP, corneal biomechanical markers, and Ocular Response Analyzer (ORA) waveform parameters were prospectively measured preoperatively and after 6 months in ablation-matched myopic LASIK eyes (mLASIK group) and LASEK eyes (mLASEK group). A retrospectively identified cohort of low myopia LASIK eyes (lmLASIK group) and fellow unoperated eyes (control) were tested at a single postoperative visit. Statistical analysis compared the percentage change in parameters between groups. RESULTS: The mean postoperative Goldmann tonometry and Goldmann-correlated IOPs were statistically significant reduced in the mLASIK and mLASEK groups (P<.03). Corneal-compensated IOP, but not Pascal dynamic contour tonometry, was significantly reduced in the mLASIK group. The percentage change in corneal hysteresis (CH) and the corneal resistance factor (CRF) was greater in the mLASIK and mLASEK groups than in the lmLASIK group. The greatest percentage change in ORA signal parameters was in the mLASIK group and the smallest change, in the mLASEK group. On multivariate linear regression, the residual stromal bed was predictive of the percentage change in CH and CRF (P<.001). CONCLUSIONS: Microkeratome flap creation combined with deeper stromal ablation had the greatest effect on the ORA applanation signal, indicating corneas that are more readily deformable. The smallest change in the signal was in the group without a stromal flap (LASEK). There was a complex interaction between ablation location and depth that affected corneal biomechanical properties.

Novel objective method for comparing ablation centration with and without pupil tracking following myopic laser in situ keratomileusis using the bausch & lomb technolas 217A.

PURPOSE: To apply an objective method to topographically determine functional optical zone (TFOZ) dimensions in order to compare ablation centration, and refractive outcomes, following myopic laser in situ keratomileusis (LASIK) with and without automated, infrared (IR) pupil tracking. METHODS: Thirty-seven eyes that underwent LASIK using the Technolas 217A with active IR pupil tracking (IT) were retrospectively compared to 37 matched eyes treated with manual tracking (MT). Visual acuity, refractive error, and corneal topography were measured pre- and postoperatively. Videokeratography and specialized software were used to assess centration. RESULTS: The IR-tracked eyes had statistically better mean postoperative spherical equivalent (IT +0.02 +/- 0.38 D; MT -0.21 +/- 0.48 D; P = 0.03) and uncorrected distance visual acuity (IT +0.07 +/- 0.08 logMAR; MT +0.02 +/- 0.09 logMAR; P = 0.02). One versus three eyes lost 1 line of best spectacle-corrected visual acuity in the IT and MT groups, respectively. While similar mean displacement of the TFOZ center from the pupil center was found in the MT (0.54 +/- 0.27 mm) and IT (0.51 +/- 0.21 mm) groups (P = 0.77), 4 MT eyes (10.8%) were topographically decentered >1.0 mm, whereas the ablation center was within 1 mm of the pupil center for all IT eyes. CONCLUSIONS: Custom software provided a novel, objective method to determine topographic functional optical zone dimensions, then mathematically calculate the center of the optical zone relative to the pupil center and measure the vector of decentration. Use of IR pupil tracking improved uncorrected visual acuity, produced more predictive refractive outcomes, and fewer large centration outliers. This may reflect increased fidelity of spot placement to the attempted ablation profile.

Comparison of contrast sensitivity, depth of field and ocular wavefront aberrations in eyes with an IOL with zero versus positive spherical aberration.

PURPOSE: To compare the clinical performance of the zero spherical aberration (SA) SofPort LI61AO (AO, Bausch & Lomb) intraocular lens (IOL) to the AcrySof SA60AT (AT, Alcon), which has positive spherical aberration. METHODS: Patients underwent uneventful phacoemulsification with implantation of either an aspheric (AO, n = 19) or spherical (AT, n = 20) IOL. Postoperatively, a 5 mm artificial pupil was positioned in trial frames with the cycloplegic refraction during monocular, mesopic contrast sensitivity (CSF) and low-contrast visual acuity (LCVA) testing with glare. Ocular and corneal wavefront error was determined at 5 mm diameters. RESULTS: Mean CSF scores were better at all frequencies tested for the AO than for the AT group, and achieved statistical significance at 1.5 cpd (p = 0.038) and 6 cpd (p = 0.017). With glare, AO eyes read 30.9 +/- 5.0 low-contrast letters versus 25.2 +/- 6.8 for AT eyes (p = 0.005) (mean DeltaLogMAR = -0.10), while high-contrast acuity and refraction were similar. Eyes implanted with the SA60AT had 43% greater positive spherical aberration at a 5 mm wavefront diameter, with no significant difference in corneal SA between groups. A through-focus analysis demonstrated a similar depth of field, yet a comparatively higher visual Strehl ratio for the aspheric IOL at emmetropia (p = 0.038). CONCLUSION: Eyes with the SofPort Advance Optics neutral aberration IOL demonstrated less spherical aberration and better low-contrast acuity compared to eyes with a spherical IOL, without sacrificing tolerance to defocus. The aspheric IOL showed superior optical and clinical performance, which is most likely due to its surface design.