Home About us Contact
|
Home About us Contact | ||
|
|
||
Acuity
Kinds of Acuity Terms modified by Acuity Selected AbstractsA cultural revolution transforms ACUITY as an employer and a business partnerGLOBAL BUSINESS AND ORGANIZATIONAL EXCELLENCE, Issue 2 2005John Signer It became clear by the late 1990s that ACUITY's approach to relationships with its employees and agents, a product of the insurance company's 70-year history, was untenable going forward. ACUITY committed to a complete change of its corporate culture. The five-year effort led to many improvements that have had positive, tangible results for both employee and agency relationships, as well as for overall operations, culminating in ACUITY's selection as best mid-sized employer in America and the best company for agents to do business with. © 2005 Wiley Periodicals, Inc. [source] Safety and Efficacy of Bivalirudin in High-risk Patients Admitted Through the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 8 2009Chadwick D. Miller MD Abstract Objectives:, The objective was to assess the safety and efficacy of bivalirudin monotherapy in patients with high-risk acute coronary syndrome (ACS) presenting to the emergency department (ED). Methods:, Data from the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial were used to conduct a post hoc subgroup analysis of high-risk ACS patients (cardiac biomarker elevation or ST-segment deviation) who initially presented to the ED. The ACUITY trial randomized patients to receive heparin (unfractionated [UFH] or enoxaparin) plus glycoprotein IIb/IIIa inhibition (GPI), bivalirudin plus GPI, or bivalirudin monotherapy. Endpoints included composite ischemia, major bleeding (not coronary artery bypass graft (CABG) related), and net clinical outcome (major bleeding plus composite ischemia). Results:, Of 13,819 participants in the ACUITY trial, 6,441 presented initially to the ED, met high-risk criteria, and were included in the primary analysis. Bivalirudin alone when compared to heparin plus GPI, after adjusting for covariates, was associated with an improvement in net clinical outcome (12.3% vs. 14.3%, adjusted odds ratio [OR] = 0.81, 95% confidence interval [CI] = 0.66 to 0.99), similar composite ischemia (9.3% vs. 9.1%, adjusted OR = 0.98, 95% CI = 0.77 to 1.24), and less major bleeding (4.0% vs. 6.8%, adjusted OR = 0.57, 95% CI = 0.42 to 0.75). Bivalirudin plus GPI when compared to heparin plus GPI had similar net clinical outcome (13.8% vs. 14.3%, adjusted OR = 0.91, 95% CI = 0.75 to 1.11), composite ischemia (8.8% vs. 9.1%, adjusted OR = 0.87, 95% CI = 0.69 to 1.11), and major bleeding (6.8% vs. 6.8%, adjusted OR = 1.01, 95% CI = 0.79 to 1.30). Conclusions: Bivalirudin monotherapy decreases major bleeding while providing similar protection from ischemic events compared to heparin plus GPI in patients with high-risk ACS admitted through the ED. [source] A visual skills inventory for children with neurological impairmentsDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 10 2007D L McCulloch OD PhD FAAO Children with neurological impairments often have visual deficits that are difficult to quantify. We have compared visual skills evaluated by carers with results of a comprehensive visual assessment. Participants were 76 children with mild to profound intellectual and/or motor impairment (33 males, 43 females; age range 7mo,16y; mean age 5y 1mo [SD 4y 2mo]) who completed a visual skills inventory before attending a special vision clinic. The inventory included 16 questions about visual skills and responses to familiar situations. Responses were augmented by taking a structured clinical history, compared with visual evoked potential (VEP) and/or acuity card measures of visual acuity, and examined using exploratory factor analysis. Acuity ranged from normal to no light perception, and was positively associated with responses to individual questions. After excluding four uninformative questions, an association between the remaining questions and two significant independent factors was found. Factor 1 was associated with questions about visual recognition (e.g. ,Does your child see a small silent toy?') and these items were correlated with both the VEP and acuity card thresholds. Factor 2 was associated primarily with questions about visually mediated social interactions (e.g. ,Does he/she return your silent smile?'). Evaluation of visual skills in children with neurological impairment can provide valid information about the quality of children's vision. Questions with the highest validity for predicting vision are identified. [source] The Effect of State Medicaid Case-Mix Payment on Nursing Home Resident AcuityHEALTH SERVICES RESEARCH, Issue 4p1 2006Zhanlian Feng Objective. To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. Data Sources. Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. Study Design. We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. Data Collection/Extraction Methods. We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. Principal Findings. Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. Conclusions. The adoption of case-mix payment increased access to care for higher acuity Medicaid residents. [source] Visual acuity in the cathemeral strepsirrhine Eulemur macaco flavifronsAMERICAN JOURNAL OF PRIMATOLOGY, Issue 4 2009Carrie C. Veilleux Abstract Studies of visual acuity in primates have shown that diurnal haplorhines have higher acuity (30,75 cycles per degree (c/deg)) than most other mammals. However, relatively little is known about visual acuity in non-haplorhine primates, and published estimates are only available for four strepsirrhine genera (Microcebus, Otolemur, Galago, and Lemur). We present here the first measurements of visual acuity in a cathemeral strepsirrhine species, the blue-eyed black lemur (Eulemur macaco flavifrons). Acuity in two subjects, a 3-year-old male and a 16-year-old female, was assessed behaviorally using a two-alternative forced choice discrimination task. Visual stimuli consisted of high contrast square wave gratings of seven spatial frequencies. Acuity threshold was determined using a 70% correct response criterion. Results indicate a maximum visual acuity of 5.1,c/deg for the female (1718 trials) and 3.8,c/deg for the male (846 trials). These values for E. macaco are slightly lower than those reported for diurnal Lemur catta, and are generally comparable to those reported for nocturnal Microcebus murinus and Otolemur crassicaudatus. To examine ecological sources of variation in primate visual acuity, we also calculated maximum theoretical acuity for Cheirogaleus medius (2.8,c/deg) and Tarsius syrichta (8.9,c/deg) using published data on retinal ganglion cell density and eye morphology. These data suggest that visual acuity in primates may be influenced by activity pattern, diet, and phylogenetic history. In particular, the relatively high acuity of T. syrichta and Galago senegalensis suggests that visual predation may be an important selective factor favoring high visual acuity in primates. Am. J. Primatol. 71:343,352, 2009. © 2009 Wiley-Liss, Inc. [source] How should we quantify the performance of KPro's?ACTA OPHTHALMOLOGICA, Issue 2009Purpose To report a method of standardized data collection and reporting and statistical assessment that can be used for all KPro´s available on the market. The database (will be presented) should be , Usable for different types of KPro´s , Easily adaptable to changes in technique , Allow for complete entry of relevant data Methods Visual Acuity data should be reported in different international surgical centres in a standardized manner: Best spectacle corrected VA, unless BCVA only possible with CL (> useful time of wear). A complete entry of all relevant data is possible in this database. The statistical analysis should be agreed upon by all centres. For Survival Time = Retention of KPro > the Kaplan-Meier method For Visual Acuity over the Course of Time > the Monte-Carlo method Results A database will be demonstrated that can be used free of charge by all KPro centres interested. The VISUAL ACUITY BY TIME- INDEX (VAT- Index) will also be presented, whose theoretical basis published in: Journal of Theoretical Medicine, 2002 / 4, 183-190, W. Hitzl and G. Grabner [bdquo]Application of the Monte Carlo Method for the Assessment of Long-term Success in Keratoprosthesis Surgery". Example of its use will be give, based in data, courtesy Barraquer Eye Clinic, Barcelona. Conclusion With the Kaplan-Meier method: + analysis is done quickly, uses all data available, hypotheses tests are available for comparisons and mean and median survival time can be computed - no information about relation between time and best corrected visual acuity and the definition of terminal event is arbitrary to a certain extent. Monte-Carlo method (VAT-index): + Method is based on a so-called non-parametric longitudinal model + Reliabel estimation of relation between time and best corrected visual acuity at any given time point (patient as well as surgeon is basically interested in this relation). + statistically valid analysis and better comparison of different KPro techniques + easy comparison of defined postoperative periods + comparison of different initial clinical findings and diseases possible + long-time follow-up of BCVA - shorter follow-up time as compared with Kaplan-Meier method (e.g. with strict [bdquo]80%data complete" criteria) [source] MOOKP clinical results and IndicationsACTA OPHTHALMOLOGICA, Issue 2009G FALCINELLI Purpose To demonstrate which are the reasons that permit by the modified osteo-odonto-keratoprosthesis (Mookp) technique to obtain in 275 blind eyes,with a basic pathology where 42% of eyes were dry,and 32% had severe physical/chemical burns,excellent anatomical and functional results. Methods Tables are shown which put into evidence the best visual acuity obtained in the 275 eyes affected by corneal blindness,operated by the Mookp technique from 1973 to 2008, with a 36 years causistry,with a very long follow-up. Results 275 blind eyes. Best Visual Acuity recovered, between 10/10 and 5/10 in 80.25% of operated eyes, excellent for any working activity,( best visual acuity recovered), between 10/10 and 2/10 in 91,20%, useful for any activity. Final V.A., between 10/10 and 5/10 in 67,68%, and between 10/10 and 2/10 in 78,11%- Conclusion The reasons for these excellent results are due to the biological properties of this Kpro invented by Strampelli and to the modifications made by Falcinelli. The indications for this technique are all those types of corneal blindness not treatable by penetrating keratoplasty. [source] Differential effects of ageing on foveal and peripheral colour visionACTA OPHTHALMOLOGICA, Issue 2009F RAUSCHER Purpose Colour sensitivity was assessed to establish aging effects both at the fovea and 6 deg away from fixation, in each of the four quadrants. Methods 65 normal healthy subjects (from 20 to 80 years of age) took part in the study. All subjects had Visual Acuity (VA) of 6/6 or better. Fixation accuracy was monitored using infrared imaging of the pupil and the tests were carried out on the P_SCAN system. Target size was adjusted for parafoveal locations to account for retinal and cortical magnification. Yellow-blue (YB) and red-green (RG) colour discrimination was assessed using the CAD (colour assessment and diagnosis) test (http://www.caa.co.uk/docs/33/200904.pdf). Results RG and YB colour thresholds were analysed separately for all five locations tested and showed no significant effect with ageing below the age of 60 years. Two age bands were formed based on statistical analysis (20-59.9 and 60-79.9). The decline in performance with age was more rapid at the fovea and exhibited a steeper gradient when compared with results in the periphery for both RG and YB discrimination. Foveal YB discrimination showed the largest ageing effect. No significant difference was found between the four parafoveal locations. YB discrimination at the fovea also exhibited the largest inter-subject variability. Conclusion These findings may have clinical significance in the very early detection of disease processes that remain subclinical in many subjects. Differences between foveal and peripheral locations help to differentiate between the normal effects of ageing and disease. For example, higher foveal and normal peripheral YB thresholds in normal subjects from high peripheral thresholds in early glaucomatous subjects. [source] Predictive Validity of a Computerized Emergency Triage ToolACADEMIC EMERGENCY MEDICINE, Issue 1 2007Sandy L. Dong MD Abstract Background Emergency department (ED) triage prioritizes patients on the basis of the urgency of need for care. eTRIAGE is a Web-based triage decision support tool that is based on the Canadian Triage and Acuity Scale (CTAS), a five level triage system (CTAS 1 = resuscitation, CTAS 5 = nonurgent). Objectives To examine the validity of eTRIAGE on the basis of resource utilization and cost as measures of acuity. Methods Scores on the CTAS, specialist consultations, computed-tomography use, ED length of stay, ED disposition, and estimated ED and hospital costs (if the patient was subsequently admitted to hospital) were collected for each patient over a six month period. These data were queried from a database that captures all regional ED visits. Correlations between CTAS score and each outcome were measured by using logistic regression models (categorical variables), univariate analysis of variance (continuous variables), and the Kruskal-Wallis analysis of variance (costs). A multivariate regression model that used cost as the outcome was used to identify interaction between the variables presented. Results Over the six month study, 29,524 patients were triaged by using eTRIAGE. When compared with CTAS level 3, the odds ratios for consultation, CT scan, and admission were significantly higher in CTAS 1 and 2 and were significantly lower in CTAS 4 and 5 (p < 0.001). When compared with CTAS levels 2,5 combined, the odds ratio for death in CTAS 1 was 664.18 (p < 0.001). The length of stay also demonstrated significant correlation with CTAS score (p < 0.001). Costs to the ED and hospital also correlated significantly with increasing acuity (median costs for CTAS levels in Canadian dollars: CTAS 1 =$2,690, CTAS 2 =$433, CTAS 3 =$288, CTAS 4 =$164, CTAS 5 =$139, and p < 0.001). Significant interactions between the data collected were found in a multivariate regression model, although CTAS score remained highly associated with costs. Conclusions Acuity measured by eTRIAGE demonstrates excellent predictive validity for resource utilization and ED and hospital costs. Future research should focus on specific presenting complaints and targeted resources to more accurately assess eTRIAGE validity. [source] Long-term outcome of children with cortical visual impairmentDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 6 2006Carey A Matsuba MDCM MHSc FRCP(C) Cortical visual impairment (CVI) is now the most common cause of visual impairment in children. Little is known about the long-term visual outcome. This study evaluates the outcome of children with congenital CVI. Using medical records, 423 children (225 males, 198 females) were identified with congenital CVI. Of these children, 259 had follow-up visual acuity assessments. The children's gestational age varied with 32 weeks or less representing 15.9%; 33 to 36 weeks representing 10.7%; 37 to 42 weeks representing 61.2%; and 43 weeks or greater representing 0.9% (11.3% of patients'gestational age was unrecorded). Clinical data were extracted and information regarding outcome was gathered. The majority of children showed improvement in their visual acuity levels after 2 or more years of follow-up. For the 194 children initially assessed before 3 years of age, 97 had improved, 75 were unchanged, 18 had deteriorated, and 4 had sub-optimal assessments. For the 74 children initially assessed at 3 or more years of age, 23 had improved, 44 remained unchanged, 3 had deteriorated, and 4 had sub-optimal testing. Children with better visual acuity levels at follow-up were more likely to have favourable cognitive outcomes (non-mental retardation)* in 12.2% versus 2.8% (p<0.01). Similarly, favourable motor outcomes (independent ambulation) were present in 20.1% for those with better visual acuities versus 7.9% for those with poorer visual acuities (p<0.01). Our study demonstrates that the majority of children with CVI underwent improvement in visual acuity. Additional disabilities were common, but those children with better visual acuity outcomes faired better. Given the frequency of comorbid conditions, appropriate diagnostic assessment services are needed. [source] Examining Contextual Effects in a Practice Analysis: An Application of Dual ScalingEDUCATIONAL MEASUREMENT: ISSUES AND PRACTICE, Issue 3 2007André F. De Champlain Practice analyses are routinely used in support of the development of occupational and professional certification and licensure examinations. These analyses usually survey incumbents to obtain importance ratings of (1) specific tasks and (2) knowledge, skill, and ability (KSA) statements deemed by subject matter experts as essential to safe and effective practice. Several researchers have made important criticisms of traditional practice analysis procedures, particularly the lack of attention to contextual constructs and the resulting problematic interpretation of mean importance ratings. The present study provides a framework for assessing the impact of context in practice analysis studies. It focuses on a practice analysis of a health profession that sought to enhance the meaning of incumbents' importance ratings by embedding the statements in the context of patient acuities. Results indicate that incumbents' importance ratings varied as a function of patient acuity. Dual scaling analysis was used to obtain a multidimensional visual representation of the associations between importance ratings and contextual content. The implications of the contextual component of the study design for future practice analysis studies are discussed as well as possible applications of this approach to professions in education. [source] Clinical performance of electronic, head-mounted, low-vision devicesOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 4 2004Louise E. Culham Abstract This study compared four electronic head-mounted devices (HMDs) (Jordy, Flipperport, Maxport and NuVision) with conventional optical low-vision aids (LVAs). The aim was to determine any performance differences for laboratory-based clinical measurements and practical visual tasks for patients with macular disease. Possible factors influencing success were explored. Ten patients with early onset macular disease (EOMD) and 10 with age-related macular disease (AMD) used the four HMDs, habitual spectacles and previously prescribed optical LVAs to complete a range of clinical measurements and everyday visual tasks. The clinical measurements were distance, intermediate and near acuities, and contrast sensitivity. The visual tasks were to read text of three sizes, to write a cheque and to identify grocery items on a shelf. Following the initial evaluation, each subject took home two randomly selected HMD devices for 2 weeks, after which performance measures were repeated. No single HMD stood out as being superior overall. Flipperport and Jordy provided significantly better distance and intermediate acuity than the previously prescribed optical LVAs but near acuity and contrast sensitivity were not consistently better with any of the HMDs. Practice at home provided some improvement in performance with HMDs, nevertheless, optical aids remained the best devices for optimum functioning for the majority of tasks. Younger patients and those with better distance acuity were more likely to benefit from HMDs, particularly when reading small print. In low vision clinics, practitioners should continue to show patients conventional optical aids and demonstrate these electronic HMDs only when appropriate for the individual patient. [source] Photoreceptor and ganglion cell topographies correlate with information convergence and high acuity regions in the adult pigeon (Columba livia) retinaTHE JOURNAL OF COMPARATIVE NEUROLOGY, Issue 5 2009Angeliza Querubin Abstract The fovea and area dorsalis are high acuity vision regions in the pigeon retina. However, the degree of neural convergence (an important determinant of acuity) has not been quantified consistently in this bird. The purpose of the study was to determine the topographic density changes and degree of photoreceptor to ganglion cell convergence in the fovea and the area dorsalis. Total photoreceptor and ganglion cell densities were calculated on the horizontal and vertical meridia. In four eyes, retinal topography was mapped for photoreceptors and ganglion cells. Rod density was quantified by counting anti-rod opsin-stained outer segments across the retina. The ratio of cone photoreceptors to ganglion cells, a rough measure of information convergence, was calculated. The fovea and the red field contained significantly higher mean cone and ganglion cell densities compared with the yellow field. Rods were missing from the fovea. Outside the fovea, rods comprised 20% of the photoreceptor population, with no significant density changes across the retina. The ratio of photoreceptors to ganglion cells was highest in the yellow field, suggesting a high degree of information convergence and low acuity. Our data indicate that convergence of cones onto ganglion cells in the red field is similar to that observed in the fovea. Convergence ratios in both the fovea and red field suggest greater visual acuity compared to that of the surrounding yellow field, which is consistent with the higher visual acuities that have been reported in these regions. J. Comp. Neurol. 517:711,722, 2009. © 2009 Wiley-Liss, Inc. [source] Intravitreal pegaptanib sodium (Macugen®) for diabetic macular oedemaACTA OPHTHALMOLOGICA, Issue 6 2009Giuseppe Querques Abstract. Purpose:, To report the functional and anatomical outcomes resulting from the use of intravitreal pegaptanib sodium (Macugen®) in patients with diabetic macular oedema (DMO). Methods:, We conducted a retrospective outcome analysis, by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA), of eyes with DMO treated with intravitreal pegaptanib sodium. Moreover, we evaluated the foveal transverse photoreceptor (PR) band integrity in the OCT images at the time of the last follow-up visit. Results:, Sixty-three eyes of 48 patients with a minimum of 6 months of follow-up were included for analysis. Intravitreal pegaptanib was found to produce significant improvements in mean BCVA (p = 0.019) and reductions in mean central macular thickness (CMT) (p < 0.001) as soon as the 6-week follow-up. Most eyes (60/63) required a mean of 3.03 ± 0.9 repeated treatments, over a mean follow-up period of 6.7 ± 1.2 months, to achieve significant improvements in mean BCVA (p < 0.001) and mean CMT (p < 0.001). In our series, the lower visual acuities tended to congregate in the group with the less-defined PR band (p < 0.001) and the lower CMT tended to congregate in the group with the best-defined PR band (p = 0.04), even though the higher CMT did not tend to congregate in the group with the less-defined PR band. Conclusion:, Our findings demonstrate that selective inhibition by intravitreal pegaptanib sodium of vascular endothelial growth factor (VEGF)-165 may produce a clinically meaningful and statistically significant benefit in the treatment of DMO. [source] New perspectives of optical coherrence tomography in diagnosis and follow-up of macular holesACTA OPHTHALMOLOGICA, Issue 2009SA KABANAROU Purpose To compare Time Domain (TD) with Spectral Domain (SD) OCT for imaging macular holes, identify retinal pathology and correlate anatomical morphology after surgical intervention for hole closure with visual outcome. Methods 34 eyes of 34 patients with idiopathic macular holes stage II- IV were included in this study. Comparative studies were performed with both SD OCT (Heidelberg, Germany) and TD OCT (Stratus) using standard scanning protocols of 6 radial 6-mm scans through the fovea. All patients underwent a standard three port- pars plana vitrectomy. Postoperatively, all patients were evaluated using both OCTs. ETDRS visual acuities were recorded pre- and post-operatively. Results In general TD and SD OCTs showed comparable images of macular holes. However, the boundary line between the inner and outer segments of the photoreceptors was better imaged with the SD OCT preoperatively and postoperatively. Poor visual acuity postoperatively was measured mainly in cases with morphological disruption in this boundary line despite hole closure. Conclusion SD OCT imaging enhances the visualization of retinal anatomy in macular holes relative to TD OCT. [source] Classification of the spectrum of Coats' disease as subtypes of idiopathic retinal telangiectasis with exudationACTA OPHTHALMOLOGICA, Issue 6 2001M. Cahill ABSTRACT. Purpose: An increasing variety of eponymous terms have been used to describe atypical cases of Coats' disease. A group of typical cases of Coats' disease and other cases of differing severity were classified as one of four subtypes of idiopathic retinal telangiectasis with exudation and compared with regard to clinical outcome. Methods: In a retrospective clinical review patients with typical and atypical Coats' disease were classified as severe, focal, juxtafoveal or associated (with another disease) forms of idiopathic retinal telangiectasis with exudation. Results: 53 eyes in 50 patients were examined of which 62% (n=31) were male. 12 eyes were classified as severe (group 1), 22 focal (group 2), 12 juxtafoveal (group 3) and 7 associated (group 4). The mean age at diagnosis was lowest in group 1 eyes (6.8 years). The best visual acuity at presentation was 6/60 in group 1 whereas high proportions of eyes in the other groups had initial visual acuities of 6/24 or better. In group 1 only one eye was treated, the majority of eyes were blind or had been enucleated whereas 34 (79%) of eyes in the other groups were suitable for treatment and 29 eyes (67%) retained pre-treatment visual acuity or better at last follow-up. Conclusions: Idiopathic retinal telangiectasis with exudation is a spectrum of disease, which is synonymous with Coats' disease. In this retrospective study eyes with severe idiopathic retinal telangiectasis with exudation corresponding to typical Coats' disease, have poorer vision at presentation, are less suitable for treatment and have worse outcomes than eyes with other subtypes. The spectrum of disease severity seen in idiopathic retinal telangiectasis with exudation may be due to second somatic mutations in genes with an existing germline mutation (the two hit theory) and a mosaic phenotype. [source] Vitreoretinal surgery in Behçet's disease with severe ocular complicationsACTA OPHTHALMOLOGICA, Issue 2 2001Yusuf Özertürk ABSTRACT. Purpose: To investigate effects of vitreoretinal surgery in Behçet's disease. Materials and Method: Vitreoretinal surgery was applied to 26 eyes of 21 patients with Behçet's disease. Preoperative and postoperative visual acuities, number and duration of attacks, anterior and posterior segment pathologies were evaluated. Results: The mean age of the patients was 33 years and female/male ratio was 6/15. The mean follow-up was 23 months. Visual acuity increased in 15 eyes (58%), did not change in 11 eyes (42%). In the postoperative period, there was a significant decrease in mean number of uveitis attacks compared to the preoperative period (p=0.001), as well as a significant decrease in the mean duration of uveitis attacks (p=0.001). In the postoperative follow-up, intravitreal haemorrhage in 2 eyes (8%), posterior subcapsular cataract in 5 eyes (19%) and corticonuclear cataract in 2 eyes (8%) were observed. Posterior capsular opacification (PCO) developed in 5 of 16 eyes (31%) having ECLE-IOL. CME continued in 3 eyes (12%). Conclusion: Vitreoretinal surgery has favourable effect on the visual and anatomic prognosis in Behçet's patients with severe ocular complications. [source] Subthreshold transpupillary thermotherapy in Chinese patients with myopic choroidal neovascularization: one- and two-year follow upCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 5 2008Pei-Chang Wu MD Abstract Background:, To perform a safety and efficacy study of subthreshold transpupillary thermotherapy (TTT) in Chinese patients with choroidal neovascularization (CNV) secondary to pathologic myopia. Methods:, In a prospective study, patients with subfoveal or juxtafoveal CNV secondary to high myopia underwent subthrehold TTT with fixed treatment and follow-up protocols. From October 2002 to July 2005, 12 and 24 months of follow up were completed for 21 eyes and 13 eyes respectively. Results:, The mean best-corrected visual acuities (BCVA) were maintained at the baseline level at 1 and 2 years. Seventy-two per cent of eyes and 63% of eyes had stable or improved BCVA at 12 and 24 months. Thirty-four per cent and 39% of eyes had a moderate gain in vision (improved by three or more lines) at 12 and 24 months respectively. The average number of subthreshold TTT treatments was 1.7. The major complication of subthreshold TTT included laser-related low-grade retinal pigment epithelium atrophy in two eyes of young patients with clear lenses. The final VA was significantly associated with pretreated VA (r = 0.614, P = 0.003). The final VA improvement was significantly associated with pretreatment VA in negative correlation (r = ,0.731, P = 0.0002, Person correlation test). Conclusions:, Subthreshold TTT in Chinese patients with pathologic myopia and subfoveal or juxtafoveal CNV generally maintained vision at 1- and 2-year follow up. Using decreased power of subthreshold TTT, especially in the younger patients with a clear lens, is suggested. [source] Avastin as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case seriesCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 5 2008Jonathan Yeoh FRANZCO Abstract Purpose:, Bevacizumab (Avastin) is a monoclonal antibody which targets all isoforms of vascular endothelial growth factor A. Its potent anti-angiogenic effects have been shown to cause regression of neovascularization in proliferative diabetic retinopathy. The aim of this study is to investigate the role of Avastin as an adjunct to vitrectomy in the management of severe diabetic eye disease. Methods:, Sixteen patients (18 eyes) with severe proliferative diabetic retinopathy were recruited into the study. All eyes underwent a single intravitreal injection of bevacizumab 1.25 mg in 0.05 mL prior to vitrectomy surgery for the management of tractional retinal detachment or vitreous haemorrhage due to severe proliferative diabetic retinopathy. Results:, At 3 months, seven eyes had visual acuities which were better than baseline, four were unchanged and seven were worse. At 6 months, 14 eyes had visual acuities better than baseline, one was unchanged and three were worse. Seven of the 18 eyes (38.8%) had postoperative rebleeds, six of which required surgical washout. Conclusion:, Avastin improved the ease of the surgery in these complex eyes and the early results are encouraging. We have found it to be particularly useful in diabetic eyes with traction detachments of short duration in which there is still active neovascularization. [source] Optic neuropathy secondary to radiotherapy for nasal melanomaCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 3 2004Helen Garrott MB BS Abstract Optic neuropathy is a rare but important complication of radiotherapy used in the treatment of cancers of the head and neck, usually resulting in rapidly progressive blindness in one or both eyes. The case is presented of a 77-year-old woman with bilateral optic neuropathy resulting in blindness, secondary to radiotherapy for a melanoma of the nasal cavity. The onset of optic neuropathy occurred 9 months post-radiotherapy, at a cumulative dose of 6000 rad. The left eye was first involved, with the right eye becoming involved within 2 weeks. Despite treatment with oral anticoagulation and high dose intravenous methylprednisolone, there was progressive deterioration resulting in bilateral optic atrophy, with final visual acuities of perception of light in the right eye and no perception of light in the left eye. This case demonstrates that oral anticoagulation was ineffective in the treatment of progressive radiation-induced optic neuropathy. [source] Clinical application of the multifocal visual evoked potentialCLINICAL AND EXPERIMENTAL OPTOMETRY, Issue 3 2004David P. Crewther PhD Background: Measures of visual function thresholds such as visual acuity and visual fields are generally dependent on subjective responses and assume maintenance of fixation, attention and motivation. In the young, elderly, cognitively impaired or malingering populations, such measures may be inaccurate or difficult to obtain. The Visual Evoked Response Imaging System (VERIS) has been claimed to give more objective topographic recordings of retinal and cortical function. This paper aims to explore the adequacy of this technique in four unusual, unrelated, clinically difficult cases. Methods: Multifocal visual evoked potentials (mfVEPs) recorded on the VERIS System 3.01 are used to assess visual function in four cases with contradictory clinical findings or unreliable subjective responses. Results: Patient 1 had sustained a head injury and had normal ocular and pupil examination but light perception in the right eye and 6/5 acuity in the left. Multifocal VEPs showed a marked depression of the right visual field with little macular response. Patient 2 had sustained a head injury, had a left field hemianopia, possible macular sparing and loss of much of the right field, reduced but variable visual acuities, good near vision and normal ocular fundi. Multifocal VEPs showed a severe depression in both visual fields (L more than R) with little macular response. Patient 3 had a left optic nerve meningioma and experienced great difficulty with visual field assessment. mfVEPs showed a bilateral depression in the superior field particularly the left field, with a larger deficit in the left eye. Patient 4 had unexplained visual acuity and peripheral field deficits. mfVEP results were inconclusive in this case. Discussion: Where there is difficulty performing traditional techniques or conflicting clinical findings, mfVEPs may provide additional objective information to aid in the assessment of patients. [source] Quality of evidence for the present Swedish child health surveillance programmeACTA PAEDIATRICA, Issue 2000S Bremberg The present Swedish health surveillance programme includes 15 examinations by a nurse, 5 examinations by a physician, 7 assessments of development, 2 assessments of hearing and 1 assessment of visual acuity. The WHO criteria for evaluation of screening programmes can be applied to the Swedish health surveillance programme. These criteria state that the health problem must be important, that there should be an early phase during which the condition is only detectable by medical professionals and that treatment at an early phase should favourably affect the prognosis. The quality of evidence for fulfilment of these criteria has been graded I-III. Grade II-2 refers to evidence obtained from well-designed cohort or case-control analytical studies. The following disorders might be affected by health surveillance at child health centres: amblyopia, ADHD/DAMP, failure to thrive, cerebral palsy, congenital heart failure, congenital luxation of hip, hearing impairment (severe or moderate), mental retardation, retentio testis and hydrocephalus. None of these conditions fulfils the WHO criteria with quality of evidence grade II-2 or better. Thus, the evidence for the present Swedish health surveillance programme is problematic. [source] The Measurement of Daily Surge and Its Relevance to Disaster PreparednessACADEMIC EMERGENCY MEDICINE, Issue 11 2006Melissa L. McCarthy MS This article reviews what is known about daily emergency department (ED) surge and ED surge capacity and illustrates its potential relevance during a catastrophic event. Daily ED surge is a sudden increase in the demand for ED services. There is no well-accepted, objective measure of daily ED surge. The authors propose that daily and catastrophic ED surge can be measured by the magnitude of the surge, as well as by the nature and severity of the illnesses and injuries that patients present with during the surge. The magnitude of an ED surge can be measured by the patient arrival rate per hour. The nature and severity of the surge can be measured by the type (e.g., trauma vs. infection vs. biohazard) and acuity (e.g., triage level) of the surge. Surge capacity is defined as the extent to which a system can respond to a rapid and sizeable increase in the demand for resources. ED surge capacity includes multiple dimensions, such as systems, space, staffing, and supplies. A multidimensional measure is needed that reflects both the core components and their relative contribution to ED surge capacity. Although many types of factors may influence ED surge capacity, relatively little formal research has been conducted in this area. A better understanding of daily ED surge capacity and influencing factors will improve our ability to simulate the potential impact that different types of catastrophic events may have on the surge capacity of hospital EDs nationwide. [source] Comparison of the Medical Priority Dispatch System to an Out-of-hospital Patient Acuity ScoreACADEMIC EMERGENCY MEDICINE, Issue 9 2006Michael J. Feldman MD Abstract Background: Although the Medical Priority Dispatch System (MPDS) is widely used by emergency medical services (EMS) dispatchers to determine dispatch priority, there is little evidence that it reflects patient acuity. The Canadian Triage and Acuity Scale (CTAS) is a standard patient acuity scale widely used by Canadian emergency departments and EMS systems to prioritize patient care requirements. Objectives: To determine the relationship between MPDS dispatch priority and out-of-hospital CTAS. Methods: All emergency calls on a large urban EMS communications database for a one-year period were obtained. Duplicate calls, nonemergency transfers, and canceled calls were excluded. Sensitivity and specificity to detect high-acuity illness, as well as positive predictive value (PPV) and negative predictive value (NPV), were calculated for all protocols. Results: Of 197,882 calls, 102,582 met inclusion criteria. The overall sensitivity of MPDS was 68.2% (95% confidence interval [CI] = 67.8% to 68.5%), with a specificity of 66.2% (95% CI = 65.7% to 66.7%). The most sensitive protocol for detecting high acuity of illness was the breathing-problem protocol, with a sensitivity of 100.0% (95% CI = 99.9% to 100.0%), whereas the most specific protocol was the one for psychiatric problems, with a specificity of 98.1% (95% CI = 97.5% to 98.7%). The cardiac-arrest protocol had the highest PPV (92.6%, 95% CI = 90.3% to 94.3%), whereas the convulsions protocol had the highest NPV (85.9%, 95% CI = 84.5% to 87.2%). The best-performing protocol overall was the cardiac-arrest protocol, and the protocol with the overall poorest performance was the one for unknown problems. Sixteen of the 32 protocols performed no better than chance alone at identifying high-acuity patients. Conclusions: The Medical Priority Dispatch System exhibits at least moderate sensitivity and specificity for detecting high acuity of illness or injury. This performance analysis may be used to identify target protocols for future improvements. [source] Cognitive visual dysfunctions in preterm children with periventricular leukomalaciaDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 12 2009ELISA FAZZI MD PHD Aim, Cognitive visual dysfunctions (CVDs) reflect an impairment of the capacity to process visual information. The question of whether CVDs might be classifiable according to the nature and distribution of the underlying brain damage is an intriguing one in child neuropsychology. Method, We studied 22 children born preterm (12 males, 10 females; mean age at examination 8y, range 6,15y; mean gestational age 30wks, range 28,36wks) with periventricular leukomalacia, spastic diplegia, normal intelligence (mean Full-scale IQ 84; mean Verbal IQ 97; mean Performance IQ 74), and normal visual acuity, focusing on higher visual functions. Brain magnetic resonance images (MRI) were analysed to establish the presence of lesions along the primary optic pathway, in the occipitoparietal and occipitotemporal regions. Results, Most children displayed an uneven cognitive profile, with deficits in visual object recognition, visual imagery, visual,spatial skills, and visual memory, and sparing of visual associative abilities, non-verbal intelligence, and face and letter recognition. Conventional brain MRI did not document major alterations of parietal and temporal white matter, or cortical alteration of areas involved in visual associative functions. Interpretation, We suggest a widespread involvement of higher visual processing systems, involving both the ventral and dorsal streams, in preterm children with periventricular leukomalacia. The lack of major alterations on conventional MRI does not exclude the possibility of malfunctioning of higher visual processing systems, expressing itself through discrete CVDs. Possible mechanisms underlying these neuropsychological deficits are discussed. [source] Young children's use of a visual aid: an experimental study of the effectiveness of trainingDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 6 2009RALF FA COX PHD We report an experiment concerning the use of a stand magnifier by young children with visual impairments (21 males, 12 females; mean age 4y 8mo [SD 11mo]). Children had a normative developmental level and a visual acuity of 0.4 or less (,20/50 in Snellen's notation). To measure magnifier use objectively, we developed a task that closely resembled the dynamics of its real-life (pre-reading) use. Children had to follow trails visually, from a start location to an unseen end location. This could only be done successfully and reliably by proper use of the magnifier. In addition to this, we analyzed the effect of specific training with the magnifier by using a repeated-measures (before and after training) matched-groups (with respect to age and near-visual acuity) design. Results established both the task's efficacy as an instrument for measuring magnifier use in young children and the effectiveness of the training. Improvement in task performance after training was found in both groups, except for the youngest children (<3y 6mo). On average, 1.8 times as many paths were followed in both groups after training (p=0.001). The without-magnifier training group became 2.5 times as good at finding the correct end location, whereas the with-magnifier training group became 4.3 times as good (p=0.05). [source] A visual skills inventory for children with neurological impairmentsDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 10 2007D L McCulloch OD PhD FAAO Children with neurological impairments often have visual deficits that are difficult to quantify. We have compared visual skills evaluated by carers with results of a comprehensive visual assessment. Participants were 76 children with mild to profound intellectual and/or motor impairment (33 males, 43 females; age range 7mo,16y; mean age 5y 1mo [SD 4y 2mo]) who completed a visual skills inventory before attending a special vision clinic. The inventory included 16 questions about visual skills and responses to familiar situations. Responses were augmented by taking a structured clinical history, compared with visual evoked potential (VEP) and/or acuity card measures of visual acuity, and examined using exploratory factor analysis. Acuity ranged from normal to no light perception, and was positively associated with responses to individual questions. After excluding four uninformative questions, an association between the remaining questions and two significant independent factors was found. Factor 1 was associated with questions about visual recognition (e.g. ,Does your child see a small silent toy?') and these items were correlated with both the VEP and acuity card thresholds. Factor 2 was associated primarily with questions about visually mediated social interactions (e.g. ,Does he/she return your silent smile?'). Evaluation of visual skills in children with neurological impairment can provide valid information about the quality of children's vision. Questions with the highest validity for predicting vision are identified. [source] Vision in children with hydrocephalusDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 10 2006Susann Andersson MD Hydrocephalus in children has many aetiologies, and can cause multiple ophthalmic and visual disorders. This study sets out to detect and quantify visual and visuoperceptual dysfunction in children who have received surgical treatment for hydrocephalus with and without myelomeningocele, and to relate the results to the associated diagnoses and results from a comparison group. Seventy-five school-aged children (41 males, 34 females) with surgically-treated hydrocephalus and 140 comparison children (76 males, 64 females) matched for age and sex underwent comprehensive ophthalmologic examination. Median age at examination was 9 years and 4 months (range 7y 4mo- 12y 10mo). Visual function deficits were identified in 83% (62/75) of the children with hydrocephalus. Visual impairment (binocular visual acuity <0.3) was found in 15% (11/73; comparison group 0%) but in none with myelomeningocele. Strabismus was found in 69% (51/74; comparison group 4% [5/140], p<0.001), and refractive errors were found in 67% (47/70; comparison group 20% [28/140], p<0.001). Cognitive visual dysfunction was identified in 59% (38/64; comparison group 3% [4/140], p<0.001). These disorders were identified in various combinations and comprised impaired ability to plan movement through depth (e.g. going down a stair), impaired simultaneous perception, impaired perception of movement, impaired orientation, and (least frequently) impaired recognition. In this study, children with hydrocephalus associated with myelomeningocele were least commonly affected. Visual disorders were most frequent in those with epilepsy, cerebral palsy, and/or cognitive disability. [source] Long-term outcome of children with cortical visual impairmentDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 6 2006Carey A Matsuba MDCM MHSc FRCP(C) Cortical visual impairment (CVI) is now the most common cause of visual impairment in children. Little is known about the long-term visual outcome. This study evaluates the outcome of children with congenital CVI. Using medical records, 423 children (225 males, 198 females) were identified with congenital CVI. Of these children, 259 had follow-up visual acuity assessments. The children's gestational age varied with 32 weeks or less representing 15.9%; 33 to 36 weeks representing 10.7%; 37 to 42 weeks representing 61.2%; and 43 weeks or greater representing 0.9% (11.3% of patients'gestational age was unrecorded). Clinical data were extracted and information regarding outcome was gathered. The majority of children showed improvement in their visual acuity levels after 2 or more years of follow-up. For the 194 children initially assessed before 3 years of age, 97 had improved, 75 were unchanged, 18 had deteriorated, and 4 had sub-optimal assessments. For the 74 children initially assessed at 3 or more years of age, 23 had improved, 44 remained unchanged, 3 had deteriorated, and 4 had sub-optimal testing. Children with better visual acuity levels at follow-up were more likely to have favourable cognitive outcomes (non-mental retardation)* in 12.2% versus 2.8% (p<0.01). Similarly, favourable motor outcomes (independent ambulation) were present in 20.1% for those with better visual acuities versus 7.9% for those with poorer visual acuities (p<0.01). Our study demonstrates that the majority of children with CVI underwent improvement in visual acuity. Additional disabilities were common, but those children with better visual acuity outcomes faired better. Given the frequency of comorbid conditions, appropriate diagnostic assessment services are needed. [source] Clinical and Economic Factors Associated with Ambulance Use to the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 8 2006Jennifer Prah Ruger PhD Background: Concern about ambulance diversion and emergency department (ED) overcrowding has increased scrutiny of ambulance use. Knowledge is limited, however, about clinical and economic factors associated with ambulance use compared to other arrival methods. Objectives: To compare clinical and economic factors associated with different arrival methods at a large, urban, academic hospital ED. Methods: This was a retrospective, cross-sectional study of all patients seen during 2001 (N= 80,209) at an urban academic hospital ED. Data were obtained from hospital clinical and financial records. Outcomes included acuity and severity level, primary complaint, medical diagnosis, disposition, payment, length of stay, costs, and mode of arrival (bus, car, air-medical transport, walk-in, or ambulance). Multivariate logistic regression identified independent factors associated with ambulance use. Results: In multivariate analysis, factors associated with ambulance use included: triage acuity A (resuscitation) (adjusted odds ratio [OR], 51.3; 95% confidence interval [CI] = 33.1 to 79.6) or B (emergent) (OR, 9.2; 95% CI = 6.1 to 13.7), Diagnosis Related Group severity level 4 (most severe) (OR, 1.4; 95% CI = 1.2 to 1.8), died (OR, 3.8; 95% CI = 1.5 to 9.0), hospital intensive care unit/operating room admission (OR, 1.9; 95% CI = 1.6 to 2.1), motor vehicle crash (OR, 7.1; 95% CI = 6.4 to 7.9), gunshot/stab wound (OR, 2.1; 95% CI = 1.5 to 2.8), fell 0,10 ft (OR, 2.0; 95% CI = 1.8 to 2.3). Medicaid Traditional (OR, 2.0; 95% CI = 1.4 to 2.4), Medicare Traditional (OR, 1.8; 95% CI = 1.7 to 2.1), arrived weekday midnight,8 AM (OR, 2.0; 95% CI = 1.8 to 2.1), and age ,65 years (OR, 1.3; 95% CI = 1.2 to 1.5). Conclusions: Ambulance use was related to severity of injury or illness, age, arrival time, and payer status. Patients arriving by ambulance were more likely to be acutely sick and severely injured and had longer ED length of stay and higher average costs, but they were less likely to have private managed care or to leave the ED against medical advice, compared to patients arriving by independent means. [source] | ||||||||||||||||