Understanding the epidemiology of ophthalmic presentations to emergency departments can help guide resource allocation, medical education programs, and optimize the patient experience. The purpose of ...this investigation was to summarize and assess the urgency of ophthalmic presentations in emergency departments (EDs) in Ontario, Canada over a 5-year period.
This was a multicentered retrospective review of all patient presentations to EDs in Ontario between January 1st, 2012, to December 31st, 2017. Presentations were included if patients had an ophthalmic related ICD-10 code as their primary problem prompting ED presentation.
A total of 774,057 patients patient presentations were included across the pediatric (149,679 patients) and adult (624,378 patients) cohorts. The mean (SD) age at presentation was 47.4 (17.9) years, and 6.54 (5.20) in the adult and pediatric cohorts respectively. Of the total presentations, 256,776 (33.1%) were due to a trauma related presentation. Problems pertaining to Cornea and External disease were the most common reason for presentation (51.0% of cases). Of all presentations, 34.1% were classified as either 'emergent' or 'likely emergent'; the remaining presentations were either 'non-emergent' (39.5%) or the urgency 'could not be determined' (26.4%). The three most frequent presentations were due to conjunctivitis (121,175 cases or 15.7%), ocular foreign bodies (104,322 cases or 13.5%), and corneal / conjunctival abrasions (94,554 cases of 12.2%).
This investigation summarizes all ophthalmic presentations to EDs in Ontario, Canada over a 5-year period. The results of this investigation can help guide ophthalmic related knowledge translation. Additionally, these results highlight that in Canadian EDs, a significant proportion of ophthalmic presentations are nonurgent; systems level efforts to improve access for eye-related complaints to healthcare professionals outside of the ED can help facilitate improved resource allocation. As we emerge from the COVID-19 pandemic, optimising the structure of patient care access is crucial to help alleviate the pressure from overburdened EDs while effectively meeting patient healthcare needs.
IntroductionThe aim of this methodological review is to evaluate the completeness of reporting of surgical pilot and feasibility randomised trials as per the Consolidated Standards of Reporting ...Trials (CONSORT) extension to randomised pilot and feasibility trials. Moreover, we aim to assess for the presence of spin reporting and inconsistency between abstract and main text reporting in surgical pilot and feasibility randomised trials.Methods and analysisA comprehensive, electronic search strategy will be used to identify studies indexed in Medline, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Studies will be included if they are pilot or feasibility randomised trials of surgical interventions. The primary outcome will be overall CONSORT statement extension to randomised pilot and feasibility trials checklist completeness. This will be defined as trials reporting each of the 40 items in the CONSORT statement extension to randomised pilot and feasibility trials checklist. Secondary outcomes will include the reporting of individual studies as per the CONSORT extension to randomised pilot and feasibility trials, the use of spin reporting strategies, trial factors associated with reporting quality and spin strategy use, and consistency between abstract and main text reporting. Poisson and logistic regressions will be performed to explore the association between trial factors and completeness of reporting as measured by the number of reported CONSORT items.Ethics and disseminationThis is a methodological survey that has been registered a priori on the International Prospective Register for Systematic Reviews (PROSPERO) (CRD42023475512). Local ethics approval is not required. We plan to disseminate study results through peer-reviewed publication and conference presentations.
IntroductionGlaucoma is a progressive, chronic condition that can have a significant impact on a patient’s health-related quality of life (HRQoL). Validated, disease-specific HRQoL tools such as the ...Health Utility for Glaucoma (HUG-5) tool and the Glaucoma Quality of Life Questionnaire (GlauQoL-17) can be used to monitor a patient’s quality of life. However, the utility of these tools in outpatient clinic practice is not well established. The primary objective of this study is to characterise the feasibility of administering periodic HRQoL questionnaires in glaucoma using a semi-automated workflow.Methods and analysisThis study will be a single-centre, unblinded, randomised, parallel-group study with an exploratory data analysis framework. We aim to determine the feasibility of administering the HUG-5 in an outpatient clinic using a semi-automated workflow and determine patient engagement through email and telephone contact methods. We will also be investigating the association of the HUG-5 and GlauQoL-17 with patient visual field testing and visual acuity. Mean differences between groups will be tested with analysis of variance to determine if the frequency of calls affects burden, satisfaction and perceived value of information.Ethics and disseminationThis study has been approved by the Hamilton Integrated Research Ethics board (ID: 13046) and will be conducted within Canadian Tri-Council Statement policy. Personal information of the study’s participants will be anonymised with identification codes and data will be kept on an encrypted server. Results of this study will be disseminated through peer-reviewed journals, conferences and internal meetings.
Objective: To evaluate the effectiveness of a novel patient intake form in an emergency ophthalmology clinic at a Canadian academic center. Despite the popularity of intake forms, they have not been ...previously reported in the literature in an emergency ophthalmology clinic setting.
Methods: All new patients at the University of Ottawa emergency ophthalmology clinic were provided with a patient intake form to complete while waiting to be seen. Ophthalmology residents and nurses at the University of Ottawa completed an effectiveness survey evaluating the benefits of these forms after 24 months of use. Emergency ophthalmology clinics at other Canadian academic institutions were questioned regarding their use of patient intake forms.
Results: Nine residents and two nurses completed the effectiveness survey. The mean (SD) score assessing the use of the form (1=never, 5=every patient encounter) was 3.90 (1.20). The greatest perceived benefit involved improved clinic efficiency (91%). All (100%) of responses indicated that the form should continue to be used in practice. Of the other 14 ophthalmology residency programs in Canada, nine currently do not use an intake form, two have forms completed by nurses and three utilize a form but are dissatisfied with their results.
Conclusions: Our results suggest that there are benefits with respect to clinic efficiency, accuracy of medical information, collaboration between healthcare professionals, and patient satisfaction when utilizing patient intake forms in an emergency ophthalmology setting. The use of similar forms may provide an opportunity to improve clinical practice at other academic institutions within Canada.
To describe the characteristics of rhegmatogenous retinal detachments (RD) that developed after endophthalmitis and to provide insight regarding incidence, management, and outcomes.
Retrospective ...chart review of consecutive patients diagnosed with endophthalmitis at two Canadian institutions and from one surgeon at a third center over a 10-year period.
316 eyes presented with endophthalmitis of which 32 (10%) were complicated by subsequent RD. The mean age (SD) of patients was 72.0 (13.77). Intravitreal injections (33%) and cataract surgery (31%) were the most common inciting events for the endophthalmitis. Cases were managed with tap and inject (16%), vitrectomy (30%) or both (47%). There were no differences in the rate of RD when comparing the inciting events, microbial growth, or management approaches. Baseline visual acuity was the only predictor of RD (p=0.009). There was an improvement in VA following management of the RD (logMAR 2.33 vs 1.69 or Snellen HM vs 20/980, p=0.009) but final VA in these patients was worse than in those who did not develop RD (logMAR 1.69 vs 1.27 or Snellen 20/980 vs 20/372, p=0.029).
All patients with RD post endophthalmitis required additional surgery and functional outcomes remained poor. Nevertheless, repair of these RDs can preserve some vision and be globe saving.
Given the key role that pilot and feasibility (PAF) trials play in addressing the challenges of surgical trials, adequate reporting completeness is essential. Our aim was to assess completeness of ...reporting and evaluate if the items of the Consolidated Standards of Reporting Trials (CONSORT) extension for PAF trials have been reported in surgical PAF trials.
This is a metaresearch study reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they were pilot or feasibility randomized trials evaluating a surgical intervention. The primary outcome was overall adherence to the CONSORT statement extension to randomized PAF trials checklist. A Poisson regression was performed to explore the association between research factors and reporting completeness.
MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from January 1-December 31, 2011 and 2021.
After screening 1991 citations, 38 studies from 2011 to 34 studies from 2021 were included. The mean CONSORT reporting score across all included studies was 21.5 (standard deviation 6.3). After excluding items that were not applicable to all studies, a mean of 20.1 (standard deviation 6.1) of 34 items (0.59) were reported. Studies published in 2021 (vs 2011) did not have a greater number of CONSORT items reported (incidence rate ratio IRR 1.01, 95% confidence interval CI 0.89–1.15). Studies registered in a clinical trial registry (IRR 1.29, 95% CI 1.12–1.48) and randomizing more than 50 patients (IRR 1.16, 95% CI 1.04–1.30) were associated with more CONSORT items reported.
The reporting completeness of surgical PAF trials is poor and has not improved after the publication of the CONSORT extension.
•The reporting completeness of surgical pilot and feasibility trials is poor.•Reporting completeness has not improved since publication of the CONSORT extension.•Registration in trial databases was associated with greater reporting completeness.•Sample sizes more than 50 were associated with greater reporting completeness.•Limitations include sampling bias, lack of statistical power, and heterogeneity.
Anti-vascular endothelial growth factor (Anti-VEGF) agents are the standard of care for diabetic macular edema (CI-DME) with vision loss. They are commonly administered using several treatment ...protocols, including fixed, pro re nata (PRN) and treat-and-extend (T&E) regimens. Because of the lack of evidence defining an ideal treatment paradigm, we systematically compared T&E with fixed or PRN regimens. Visual acuity improvement was similar when comparing T&E to fixed or PRN dosing at 12 and 24 months. Regarding anatomic outcomes, no significant difference was found between T&E and fixed regimens for central retinal thickness or central subfoveal thickness at 12 and 24 months. Similarly, no significant difference was found for central retinal thickness at 12 months for T&E versus PRN regimen. Regarding total number of injections, no significant difference existed between T&E versus fixed regimens at 12 months. PRN regimens delivered fewer injections compared to T&E regimens at 12 months.
The results of this analysis support that visual acuity and anatomic outcomes at 12 and 24 months are similar between T&E with either fixed or PRN regimens. More head-to-head trials comparing T&E versus fixed and PRN dosing are needed to provide visual and functional outcome data beyond year 2. PROSPERO Registration: CRD42021249362.
PURPOSE:Glaucoma is the second leading cause of irreversible blindness in the world, with 60 million people worldwide estimated to suffer from the condition. Health utility is an important outcome ...measure of treatment effect in economic outcomes. The available tools for the measurement of health utility in glaucoma patients do not support a preference-based algorithm required to estimate health utility. To resolve this gap in the literature, the HUG-5 (Health Utility for Glaucoma—5 dimensions) was developed. The objective of the present study was to validate the HUG-5 with accepted measures of health state and vision-specific quality of life.
MATERIALS AND METHODS:The HUG-5 measures patient self-reported levels of visual discomfort, mobility, daily life activities, emotion, and social activities, as affected by the progression and management of glaucoma. To evaluate the psychometric properties, the HUG-5 was assessed for construct validity between similar and dissimilar dimensions of the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and the EuroQol’s 5 Dimensions. The HUG-5 was evaluated for test-retest reliability after a 2-week period. The HUG-5 composite distributions of mild/moderate and advanced glaucoma patients were tested for differences to measure sensitivity.
RESULTS:A total of 124 patients with glaucoma were administered the NEI-VFQ-25, the HUG-5, and the EuroQol’s 5 Dimensions. The HUG-5 demonstrated construct validity, with convergent and discriminant support for visual discomfort, mobility, daily life activities, emotional distress, and social activities. The HUG-5 concurrently measured health-related quality of life associated with best-eye visual field loss (r=0.63, P<0.001). The HUG-5 measured health state consistently with test-retest reliability (intraclass correlation=0.91, P<0.001). The HUG-5 was established to be sensitive in detecting differences between patients with mild/moderate glaucoma and those with advanced glaucoma with a rank-sum test with continuity correction (W=693.5, P<0.001).
CONCLUSIONS:This study demonstrates promising results for the HUG-5’s response range and relationship with the NEI-VFQ-25 and best-eye visual field loss, highlighting the value of disease-specific preference-based scoring systems in measuring health state changes in glaucoma patients.
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