Accuracy of a low-cost, portable, refractive error estimation device: Results of a diagnostic accuracy trial.

PURPOSE: To assess the accuracy of refraction measurements by ClickCheckTM compared with the standard practice of subjective refraction at a tertiary level eye hospital. DESIGN: Diagnostic accuracy trial. METHODS: All participants, recruited consecutively, underwent auto-refraction (AR) and subjective refraction (SR) followed by refraction measurement using ClickCheckTM (CR) by a trained research assistant. Eyeglass prescriptions generated using ClickCheckTM and the resulting visual acuity (VA) was compared to SR for accuracy. Inter-rater reliability and agreement were determined using Intra-class correlation and Bland Altman analysis respectively. RESULTS: The 1,079 participants enrolled had a mean (SD) age of 39.02 (17.94) years and 56% were women. Overall, 45.3% of the participants had refractive error greater than ±0.5D. The mean (SD) spherical corrections were -0.66D (1.85) and -0.89D (2.20) in SR and CR respectively. There was high level of agreement between the spherical power measured using SR and CR (ICC: 0.940 (95% CI: 0.933 to 0.947). For the assessment of cylindrical correction, there was moderate level of agreement between SR and CR (ICC: 0.493 (0.100 to 0.715). There was moderate level of agreement between the VA measurements performed by using corrections from SR and CR (ICC: 0.577 (95% CI: 0.521-0.628). The subgroup analysis based on the age categories also showed high level of agreement for spherical corrections between the two approaches (ICC: 0.900). Bland Altman analysis showed good agreement for spherical corrections between SR and CR (Mean difference: 0.224D; 95% LoA: -1.647 D to 2.096 D) without evidence of measurement bias. CONCLUSIONS: There was a high level of agreement for spherical power measurement between CR and SR. However, improvements are needed in order to accurately assess the cylindrical power. Being a portable, low-cost and easy-to-use refraction device, ClickCheckTM can be used for first level assessment of refractive errors, thereby enhancing the efficiency of refractive services, especially in low- and-middle-income countries.

Comparison of two phacoemulsification system handpieces: prospective randomized comparative study.

PURPOSE: To compare the safety and efficacy of Active Sentry handpiece with Ozil handpiece for Centurion phacoemulsification system. SETTING: Tertiary eye center, South India. DESIGN: Prospective observational study. METHODS: 204 eyes of 204 patients with uncomplicated cataract who underwent phacoemulsification cataract surgery with Centurion Vision System were randomized into 2 groups: Ozil handpiece (n = 101) and Active Sentry handpiece (n = 103). Intraoperative factors such as patient pain perception, surgeon comfort level, amount of phacoemulsification energy and aspiration fluid used, and frequency of activation of active surge mitigation (ASM) were analyzed, and postoperatively, corrected distance visual acuity (CDVA) and corneal edema on day 1 were compared. RESULTS: A total of 204 eyes of 204 patients were included among which 101 underwent surgery with ozil hand piece and 103 with Active Sentry handpiece. Patient pain perception was comparable between the groups with no statistically significant differences in patients who had pain-free surgery (66% vs 61.3%) and those who experienced moderate pain (24.3% vs 28.7%). Surgeons were more comfortable using Ozil handpiece during entry into anterior chamber and emulsification of hard nuclei (48.5% vs 28.6%). The mean cumulative dissipated energy for soft and hard cataracts was 5.6 and 4.8 and 9.3 and 9.4 for Ozil and Active Sentry groups, respectively. ASM was activated for 53 eyes (51.5%), of which 42 eyes (79.2%) had soft cataract and 11 eyes (20.7%) hard cataract. Postoperative CDVA and incidence of corneal edema were comparable between the groups. CONCLUSIONS: For Centurion Vision System, Active Sentry handpiece was as safe and efficacious as the Ozil handpiece with added benefit of operating at lower intraocular pressure levels.

Reliability of dipstick assay in predicting urinary tract infection.

AIMS: Urine dipstick analysis is a quick, cheap and a useful test in predicting Urinary Tract Infection (UTI) in hospitalized patients. Our aim is to evaluate the reliability (sensitivity) of urine dipstick analysis against urine culture in the diagnosis of UTI. MATERIALS AND METHODS: Patients admitted to our hospital suspected of having UTI, with positive urine cultures were included in this study from a 2-year period (January 2011 to December 2012). Dipstick urinalysis was done using multistix 10 SG (Siemens) and clinitek advantus analyzer. The sensitivity of dipstick nitrites, leukocyte esterase and blood in these culture-positive UTI patients was calculated retrospectively. RESULTS: Urine dipstick analysis of 635 urine culture-positive patients was studied. The sensitivity of nitrite alone and leukocyte esterase alone were 23.31% and 48.5%, respectively. The sensitivity of blood alone in positive urine culture was 63.94%, which was the highest sensitivity for a single screening test. The presence of leukocyte esterase and/or blood increased the sensitivity to 72.28%. The sensitivity was found to be the highest when nitrite, leukocyte and blood were considered together. CONCLUSIONS: Nitrite test and leukocyte esterase test when used individually is not reliable to rule out UTI. Hence, symptomatic UTI patients with negative dipstick assay should be subjected to urine culture for a proper management.