National survey of back & neck pain amongst consultant ophthalmologists in the United Kingdom.

Repetitive tasks, awkward or prolonged working postures, and high cognitive load are risk factors for occupational musculoskeletal disorders. Ophthalmologists may be vulnerable given that they are exposed to a combination of these factors. This national study assesses the prevalence, severity and associations of back and neck pain amongst UK consultant ophthalmologists. A postal survey was conducted using addresses supplied by the Royal College of Ophthalmologists. Statistical analysis was performed using Pearson correlation coefficient, two-tailed probability testing, analysis of variance (ANOVA) and Dunn's multiple comparison test. 518 responses were received (50.3 % response rate). Back and neck pain were reported by 50.6 % (262/518) and 31.8 % (165/518) of respondents, respectively, with 62.4 % (323/518) reporting one or both. 33.6 % (174/518) reported pain whilst operating, of whom 78.7 % (137/174) found operating exacerbated their pain. 31.7 % (164/518) reported pain when using the slit lamp, of whom 71.3 % (117/164) found it exacerbated their pain. Individual subspecialties showed a significant relative risk of back or neck pain in some circumstances, when compared to ophthalmologists as a whole. Occupational back and neck pain remains a problem amongst ophthalmologists. Recommendations are made for modifications to the working environment, and consideration should be given to improving education for trainees.

Description and evaluation of the first national patient and public involvement day for thyroid eye disease in the United Kingdom.

BACKGROUND: To ensure appropriate patient-focused outcomes, the National Institute for Health Research (NIHR) in the United Kingdom has made consultation with patients, caregivers, and the public a prerequisite to providing research funding. One method of encouraging engagement with research is through patient and public involvement (PPI) events. We describe the planning and implementation of a PPI day for thyroid eye disease (TED) and evaluate our own event using feedback from delegates. METHODS: The Moorfields NIHR Biomedical Research Centre, in partnership with TED charities, arranged the first national PPI day for TED in the United Kingdom. The event included didactic lectures; pre-event and postevent questionnaires; an exhibition with stalls, posters, and an interactive voting wall to determine research priorities; focus group sessions to explore patient experiences and perceptions of research; and one-on-one interviews recording individual patient stories. RESULTS: Of 100 attendees, 70 completed questionnaires. When asked whether the day had provided what they wanted, 48 of 52 (92%) said yes; 3 of 52 (6%) said no. Overall 6 of 52 (12%) rated the event as good; 28 of 52 (54%), very good; and 18 of 52 (34%), excellent. Thirty-six patients registered to participate in further research, identifying "finding the cause for TED," "improving psychological support," and "achieving a better cosmetic outcome" as key priorities. A poor understanding of TED among medical professionals was a common complaint. CONCLUSIONS: The event received positive feedback and achieved its key objective of engaging patients, researchers, and clinicians in a two-way discussion about research priorities and improved study design. An invaluable insight was gained into patients' needs for a better quality of life, and we have demonstrated that important data can be captured from such events, providing an evidential basis consistent with the NIHR principles of patient-centered research.

Patient-reported benefit from botulinum toxin treatment for essential blepharospasm: using 2 assessment scales.

PURPOSE: To assess and compare the change in quality-of-life and function following treatment with botulinum toxin (BTX) using the Glasgow Benefit Inventory (GBI) and Blepharospasm Disability Index (BSDI) scores. METHODS: A cross-sectional study of 62 consecutive patients treated with BTX for blepharospasm conducted during a postinterventional telephone interview. Post hoc analysis converts the GBI to a score from -100 (maximum harm) through 0 (no effect) to +100 (maximum benefit). The BSDI is converted to a score on a scale from -4 (maximum harm) through 0 (no effect) to +4 (maximum benefit). A Wilcoxon signed-rank test and linear regression analysis were performed. RESULTS: A statistically significant benefit (Wilcoxon signed-rank test) from treatment of 31.36 (95% confidence interval = 26.22-36.50; p < 0.001) and 1.04 (95% confidence interval = 0.80-1.27; p < 0.001) using the GBI and BSDI scores, respectively. Regression analysis was performed demonstrating a strong positive correlation between both scales (r = 0.637). CONCLUSIONS: BTX treatment for blepharospasm is associated with significant patient-reported improvements in quality-of-life (GBI) and functional ability (BSDI) with a strong positive correlation between both scores.

Keratometry obtained by corneal mapping versus the IOLMaster in the prediction of postoperative refraction in routine cataract surgery.

BACKGROUND: To establish whether simulated keratometry values obtained by corneal mapping (videokeratography) would provide a superior refractive outcome to those obtained by Zeiss IOLMaster (partial coherence interferometry) in routine cataract surgery. DESIGN: Prospective, non-randomized, single-surgeon study set at the The Royal United Hospital, Bath, UK, District General Hospital. PARTICIPANTS: Thirty-three patients undergoing routine cataract surgery in the absence of significant ocular comorbidity. METHODS: Conventional biometry was recorded using the Zeiss IOLMaster. Postoperative refraction was calculated using the SRK/T formula and the most appropriate power of lens implanted. Preoperative keratometry values were also obtained using Humphrey Instruments Atlas Version A6 corneal mapping. MAIN OUTCOME MEASURES: Achieved refraction was compared with predicted refraction for the two methods of keratometry after the A-constants were optimized to obtain a mean arithmetic error of zero dioptres for each device. RESULTS: The mean absolute prediction error was 0.39 dioptres (standard deviation 0.29) for IOLMaster and 0.48 dioptres (standard deviation 0.31) for corneal mapping (P = 0.0015). Keratometry readings between the devices were highly correlated by Spearman correlation (0.97). The Bland-Altman plot demonstrated close agreement between keratometers, with a bias of 0.0079 dioptres and 95% limits of agreement of -0.48-0.49 dioptres. CONCLUSIONS: The IOLMaster was superior to Humphrey Atlas A6 corneal mapping in the prediction of postoperative refraction. This difference could not have been predicted from the keratometry readings alone. When comparing biometry devices, close agreement between readings should not be considered a substitute for actual postoperative refraction data.

Grading severity in retinitis pigmentosa using clinical assessment, visual acuity, perimetry and optical coherence tomography.

To develop a grading system for retinitis pigmentosa (RP), providing clinicians with a simple, objective measure of disease severity. An observational case series of 14 patients with RP. Disease severity was assessed using four criteria; clinical appearance, visual acuity (best corrected LogMAR, BCVA), perimetry (mean deviation, MD) and Fourier-domain optical coherence tomography (outer retinal thickness, ORT at the fovea). Each criterion was scored on a severity scale from 0 (mild disease) to 4 (severe disease), giving an overall score out of 16. The mean BCVA was 0.37 LogMAR (range 0.02 to PL), mean MD was -25.35 dB (range -7.48 to -34.38 dB), mean retinal thickness at the fovea was 189.4 µm (range 96.5-264.5 µm) and mean ORT at the fovea was 140.6 µm (range 63.4-193.4 µm). The clinical appearance correlated well with each of the quantitative measures of disease severity; BCVA (0.62, p = 0.022), MD (-0.903, p < 0.0001) and ORT (-0.698, p = 0.005). Applying the grading system to our patients, the severity scores were evenly spread between grades 1 and 14. We present a simple, objective grading system for RP offering a potential tool for grading disease severity with applications such as assessing progression, comparing patient populations and measuring outcomes in clinical trials.

Combined phacoemulsification and removal of gas following macular hole surgery.

We describe a technique for combined fluid-gas exchange and phacoemulsification 2 weeks after macular hole surgery to achieve rapid visual rehabilitation. The procedure uses a standard cataract set and requires minimal vitreoretinal expertise. We encountered no significant complications and obtained long-term outcomes comparable to those with conventional management.

Scleral punch method with topical mitomycin C for safe revision of failed deep sclerectomy in nanophthalmic uveal effusion syndrome.

PURPOSE: To describe a novel surgical technique for revision of deep sclerectomy surgery in nanophthalmic uveal effusion syndrome. METHODS: A 46-year-old woman with recessively inherited nanophthalmos and chronic uveal effusions underwent a revision of previous failed deep sclerectomy surgery. In the presence of scar tissue, revision of sclerectomies was greatly facilitated by the use of a Kelly scleral punch (Katena Products, Inc., Denville, NJ, USA). To inhibit further scarring, mitomycin-C (MMC) was applied topically in each quadrant posterior to the equator. RESULTS: The scleral punch allowed outward scleral dissection from the suprachoroidal space, and brisk enlargement of sclerectomies in all quadrants without perforation of choroidal tissue. Post-operative conjunctival wound healing appeared unimpeded by the posteriorly placed MMC sponges. Near-total resolution of the effusions had occurred by 3 months. CONCLUSIONS: The scleral punch provides a safe and effective method for constructing and revising full-thickness sclerectomies in the nanophthalmic eye, minimizing the risk of choroidal trauma. The use of topical MMC may reduce the risk of late failure of trans-scleral outflow due to fibrosis.