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Tan Yip Ming C, Rojas-Carabali W, Cifuentes-González C, Agrawal K, Grover S, Anand A, Singh Senjam S, Singh A, Dubey P, Sharma A, Blazes M, Lee CS, Lee AY, Gupta V, Agrawal R. Beyond Pathology- Exploring Salutogenesis as a Novel Approach to Eye Inflammatory Disease Prevention and Management: A Perspective. Ocul Immunol Inflamm 2024:1-9. [PMID: 38842198 DOI: 10.1080/09273948.2024.2359621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
The aim of this perspective is to promote the theory of salutogenesis as a novel approach to addressing ophthalmologic inflammatory conditions, illustrating several concepts in which it is based upon and how they can be applied to medical practice. This theory can better contextualize why patients with similar demographics and exposures are not uniform in their clinical presentations. Stressors in daily life can contribute to a state of ill-health and there are various factors that help alleviate their negative impact. These alleviating factors are significantly impaired in people with poor vision, one of the most common presentations of ophthalmologic conditions. Salutogenic principles can guide the treatment of eye conditions to be more respectful of patient autonomy amidst shifting expectations of the doctor-patient relationship. Being able to take ownership of their health and feeling that their cultural beliefs were considered improves compliance and subsequently gives more optimal outcomes. Population-level policy interventions could also utilize salutogenic principles to identify previously overlooked domains that can be addressed. We identified several papers about salutogenesis in an ophthalmological context and acknowledged the relatively few studies on this topic at present and offer directions in which we can explore further in subsequent studies.
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Affiliation(s)
- Collin Tan Yip Ming
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - William Rojas-Carabali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Carlos Cifuentes-González
- PROTON Study Group, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kajal Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sandeep Grover
- PROTON Study Group, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Akshay Anand
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suraj Singh Senjam
- NeuroScience Research Lab, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amarjeet Singh
- Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Preeti Dubey
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Aman Sharma
- Gap Analysis, Strive High Pte Ltd, Singapore, Singapore
| | - Marian Blazes
- Department of Rheumatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Cecilia S Lee
- Department of Rheumatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aaron Y Lee
- Department of Rheumatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advance Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Ophthalmology, University of Washington, Seattle, USA
- Singapore Eye Research Institute, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
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Sherief ST, Tesfaye S, Eshetu Z, Ali A, Dimaras H. Exploring the knowledge, attitudes, and practice towards child eye health: A qualitative analysis of parent experience focus groups. PLoS One 2023; 18:e0293595. [PMID: 37922264 PMCID: PMC10624311 DOI: 10.1371/journal.pone.0293595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/17/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND The majority of childhood blindness causes in low-income countries are treatable or avoidable. Parents or guardians are responsible for making decisions regarding a child's eye care. Understanding parents' awareness and perception of eye problems in crucial in helping to know parents' eye care-seeking behavior. OBJECTIVE To determine parental knowledge, attitudes and practice regarding child eye health. METHODS Seven focus groups were carried out in Northwest Ethiopia on knowledge, attitude and practice of parents towards child eye health. Their responses were tape-recorded and later transcribed. A thematic phenomenological approach was used for the analysis. RESULT Seventy-one parents participated in the focus groups. Participants were aware of common eye problems like trachoma, trauma, and glaucoma. However, they were unaware of the causes and etiologies of childhood blindness. Participants perceived that eye problems could be treated with hygiene and food, and often held misconceptions about the cause of strabismus and utilization of wearing spectacles. CONCLUSION The study revealed that parents are often unaware of the causes and etiologies of common childhood eye diseases, which has downstream effects on health-seeking behavior. Health promotion efforts, potentially through mass and social media, could be helpful to raise awareness, coupled with training of health professionals at primary and secondary health facility levels.
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Affiliation(s)
- Sadik Taju Sherief
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
- Child Health Evaluative Sciences Program and Centre for Global Child Health, Sickkids Research Institute, Toronto, Canada
| | | | - Zelalem Eshetu
- Biruh Vision Speciality Eye Center, Addis Ababa, Ethiopia
| | - Asim Ali
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Helen Dimaras
- Child Health Evaluative Sciences Program and Centre for Global Child Health, Sickkids Research Institute, Toronto, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
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Optimising fundoscopy practices across the medical spectrum: A focus group study. PLoS One 2023; 18:e0280937. [PMID: 36706098 PMCID: PMC9882965 DOI: 10.1371/journal.pone.0280937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Fundoscopy can be of great clinical value, yet remains underutilised. Educational attempts to improve fundoscopy utilisation have had limited success. We aimed to explore the barriers and facilitators underlying the uptake of clinical direct ophthalmoscopy across a spectrum of medical specialties and training levels. METHODS Ten focus groups were conducted with medical students (n = 42), emergency department doctors (n = 24), basic physician trainees (n = 7), hospital physicians (n = 6) and general practitioners (n = 7). Independent thematic analysis of transcripts was conducted by three investigators. A consensus thematic framework was developed, and transcripts were reanalysed using this framework. RESULTS Thematic analysis identified seven main themes: (1) technical barriers to performing fundoscopy examinations; (2) clinical culture and expectations regarding fundoscopy; (3) the influence of fundoscopy on clinical management; (4) motivation to perform the examination; (5) novel technology including smartphone fundoscopy, and the value of a digital fundus image; (6) training requirements, and; (7) use of limited resources. CONCLUSION Our results build a more nuanced picture of the factors which determine fundoscopy utilisation. As current barriers limit practice by clinicians and medical students, expertise and confidence performing and interpreting fundoscopy are lost. This shifts the balance of perceived clinical utility to futility in changing patient management, and reinforces a cycle of reducing fundoscopy utilisation. We identified important cultural barriers such as accepted incompetence, and misperceptions of senior discouragement. Emerging technologies reduce the technical barriers to fundoscopy. Therefore education should: focus on detecting pathology from digital images; clarify the role of fundoscopy in patient management, and; be targeted at key career progression points.
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Talks SJ, Daien V, Mitchell P, Aslam T, Barratt J, Biberger A, Lamoureux EL, Hirst C, Sylvanowicz M, Finger RP. The Patient Voice in Neovascular Age-Related Macular Degeneration: Findings from a Qualitative Study. Ophthalmol Ther 2022; 12:561-575. [PMID: 36525220 PMCID: PMC9756919 DOI: 10.1007/s40123-022-00631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Visual impairment resulting from diseases such as neovascular age-related macular degeneration (nAMD) may cause behavioural, environmental, psychological, and logistical challenges that could act as barriers to effective uptake and sustainability of treatment with anti-vascular endothelial growth factor agents (anti-VEGFs). Understanding emotions and experiences of patients with nAMD may help inform the determinants of adherence, and could contribute to improvements in ophthalmic outcomes and quality of life. METHODS Seventeen patients with nAMD receiving anti-VEGF injections were enrolled from three clinics: one each in France (n = 5), Germany (n = 6), and the UK (n = 6). Patients' health information and treatment characteristics were collected. Individual phone interviews were conducted by experienced health care interviewers. Transcripts were analysed thematically. RESULTS Patients (53% female) had a mean age of 77 years. Bilateral anti-VEGF injections were received by 24% (n = 4); and most (76%, n = 13) were adherent to their treatment. Patient emotions at diagnosis ranged from happiness at learning about the treatment for nAMD to being terrified of receiving an injection in the eye. Most patients mentioned feeling anxious and fearful before their first injection despite receiving reassurance. After the first injection, these feelings and apprehension abated for many, but not all. With the goal of maintaining the best possible vision, few (24%, n = 4) patients reported more than one missed appointment, and most had never considered stopping treatment. No patient reported additional assistance beyond family support; however, many had difficulties with recreational and domestic activities and had developed coping strategies. CONCLUSION This study provides insights on patients' emotions related to their experience of nAMD and its management, highlighting the varying experiences between individuals. It shows the importance of the patient's voice when considering patient care and management, and how the nature and timing of interventions can improve the experience of living with and managing nAMD.
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Affiliation(s)
- S. James Talks
- grid.420004.20000 0004 0444 2244Newcastle Eye Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vincent Daien
- grid.157868.50000 0000 9961 060XDepartment of Ophthalmology, University Hospital of Montpellier, Montpellier, France
| | - Paul Mitchell
- grid.1013.30000 0004 1936 834XUniversity of Sydney (Westmead Institute for Medical Research), Sydney, NSW Australia
| | - Tariq Aslam
- grid.416375.20000 0004 0641 2866Manchester Royal Eye Hospital, Manchester, UK ,grid.5379.80000000121662407University of Manchester, Manchester, UK
| | - Jane Barratt
- grid.511577.00000 0001 0942 4326International Federation on Ageing, Toronto, ON Canada
| | | | - Ecosse L. Lamoureux
- grid.272555.20000 0001 0706 4670Singapore Eye Research Institute, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, Singapore, Singapore
| | - Ceri Hirst
- grid.483721.b0000 0004 0519 4932Bayer Consumer Care AG, Basel, Switzerland
| | | | - Robert P. Finger
- grid.10388.320000 0001 2240 3300Department of Ophthalmology, University of Bonn, Bonn, Germany
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Chen BS, Galus T, Archer S, Tadić V, Horton M, Pesudovs K, Braithwaite T, Yu-Wai-Man P. Capturing the experiences of patients with inherited optic neuropathies: a systematic review of patient-reported outcome measures (PROMs) and qualitative studies. Graefes Arch Clin Exp Ophthalmol 2022; 260:2045-2055. [PMID: 35024911 PMCID: PMC9061690 DOI: 10.1007/s00417-021-05534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/07/2021] [Accepted: 12/16/2021] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To identify and comprehensively evaluate studies capturing the experience of individuals affected by an inherited optic neuropathy (ION), focusing on patient-reported outcome measures (PROMs) and qualitative studies where the health status and quality of life (QoL) of these individuals have been explored. METHODS Systematic review of five databases using a search strategy combining four concepts: (1) ION; (2) QoL and health status; (3) PROMs; and (4) qualitative research. Studies assessing the impact of ION on any QoL domain using a PROM or qualitative methodology were included and appraised, using criteria based on the COSMIN checklist (for PROM studies) and the CASP checklist (for qualitative studies). RESULTS Of 1326 unique articles identified, six studies were included. Five PROMs were identified: Visual Function Index (VF-14); Hospital Anxiety and Depression Scale (HADS); a novel graphical online assessment tool (NGOAT) for reporting emotional response to vision loss; a new PROM informed by the DSM-V Criteria for Major Depressive Disorder; and an interpersonal and career 'impact rating' PROM. The psychometric performance of included PROMs were poorly described. Qualitative studies found that vision loss resulted in psychosocial losses including loss of social and communication skills and loss of independence and freedom. Factors that modified the response to vision loss were also identified. CONCLUSION The current PROMs used by individuals with ION have poor content coverage, primarily measuring activity limitation and emotional well-being, and insufficient reporting of psychometric performance. There is a need to develop a PROM for individuals ION to report their experiences of living with their condition.
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Affiliation(s)
- Benson S Chen
- John Van Geest Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
| | - Tomasz Galus
- John Van Geest Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Stephanie Archer
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Valerija Tadić
- School of Human Sciences, University of Greenwich, London, UK
| | - Mike Horton
- Psychometric Laboratory for Health Sciences, University of Leeds, Leeds, UK
| | - Konrad Pesudovs
- School of Optometry and Vision Science, University of New South Wales, Kensington, Australia
| | - Tasanee Braithwaite
- School of Life Course Sciences, King's College London, London, UK
- The Medical Eye Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Patrick Yu-Wai-Man
- John Van Geest Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
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Hudson SM, Modjtahedi BS, Altman D, Jimenez JJ, Luong TQ, Fong DS. Factors Affecting Compliance with Diabetic Retinopathy Screening: A Qualitative Study Comparing English and Spanish Speakers. Clin Ophthalmol 2022; 16:1009-1018. [PMID: 35400992 PMCID: PMC8992739 DOI: 10.2147/opth.s342965] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sharon M Hudson
- Keck School of Medicine of USC/Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Bobeck S Modjtahedi
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
- Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Correspondence: Bobeck S Modjtahedi, Eye Monitoring Center, Kaiser Permanente Baldwin Park Medical Center, 1011 Baldwin Park Blvd, Baldwin Park, CA, 91706, USA, Email
| | - Danielle Altman
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Jennifer J Jimenez
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Tiffany Q Luong
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Donald S Fong
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
- Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA
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Lohfeld L, Graham C, Ebri AE, Congdon N, Chan VF. Parents' reasons for nonadherence to referral to follow-up eye care for schoolchildren who failed school-based vision screening in Cross River State, Nigeria-A descriptive qualitative study. PLoS One 2021; 16:e0259309. [PMID: 34793502 PMCID: PMC8601460 DOI: 10.1371/journal.pone.0259309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Uncorrected refractive error (URE) is a major cause of vision impairment in children worldwide. Cases are often detected through a school-based vision screening program and then treated in a follow-up appointment. This requires parents or guardians ('parents') to adhere to referrals for the eye exam and care plan. We aim to understand the reasons for parents' referral non-adherence in Cross River State, Nigeria, using qualitative methods. METHODS Ten focus groups were held with parents who had not adhered to the referral for a follow-up eye examination. Participants were recruited with help from staff in schools hosting the vision screening programme. Interviews were conducted using a semi-structured interview guide, audio taped and transcribed verbatim. After identifying relevant quotes, the researchers labelled each one with a descriptive code/subcode label. Then they clustered the data into categories and overarching themes. RESULTS Forty-four parents participated in 10 focus group discussions with 28 women and 16 men. Three themes and participated in the focus group discussions with 28 women (63%). Twelve themes were generated. The three megathemes were Modifiable Factors (with 4 themes), Contextual Factors (with 6 themes), and Recommendations (with 2 themes). CONCLUSION Participants identified modifiable barriers that make it difficult for parents to adhere to a referral for a follow-up eye exam. These include not believing their child has a vision problem or the screening test, and issues with the referral letter. They also described important contextual factors such as poverty, logistical problems, parental attitudes towards their children and beliefs about appropriate care. Many of these issues could be addressed by following their recommendation to educate the public on the importance of child eye care and correct parents' misconceptions. These themes will be used by the Nigerian government to enhance and scale up its child eye health programme.
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Affiliation(s)
- Lynne Lohfeld
- Centre for Public Health, School of Medicine, Dentistry and Biological Sciences, Queen’s University Belfast, Northern Ireland, United Kingdom
- Clinical and Epidemiological Eye Research Center, Wenzhou Medical University, Wenzhou, China
- * E-mail:
| | - Christine Graham
- Nelson R. Mandela School of Medicine, KwaZulu Natal, Durban, South Africa
| | - Anne Effiom Ebri
- Brien Holden Vision Institute Foundation (Africa) Trust, Durban, South Africa
| | - Nathan Congdon
- Centre for Public Health, School of Medicine, Dentistry and Biological Sciences, Queen’s University Belfast, Northern Ireland, United Kingdom
- Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
- Orbis International, New York, NY, United States of America
| | - Ving Fai Chan
- Centre for Public Health, School of Medicine, Dentistry and Biological Sciences, Queen’s University Belfast, Northern Ireland, United Kingdom
- College of Health Sciences, University KwaZulu Natal, Durban, South Africa
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Lahiri S, Sumodhee D, Alkarmi K, Pontikos N, Petrushkin H, Gilbert R. Exploring the potential for acute anterior uveitis (AAU) patients to self-manage recurrences via a mobile application: qualitative analysis of a Moorfields Patient Experience focus group. Eye (Lond) 2021; 35:2895-2896. [PMID: 32968219 PMCID: PMC8452635 DOI: 10.1038/s41433-020-01190-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Shweta Lahiri
- grid.83440.3b0000000121901201UCL Medical School, London, UK
| | - Dayyanah Sumodhee
- grid.4868.20000 0001 2171 1133Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Khaled Alkarmi
- grid.436474.60000 0000 9168 0080Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Nikolas Pontikos
- grid.436474.60000 0000 9168 0080Moorfields Eye Hospital NHS Foundation Trust, London, UK ,grid.83440.3b0000000121901201UCL Institute of Ophthalmology, London, UK
| | - Harry Petrushkin
- grid.436474.60000 0000 9168 0080Moorfields Eye Hospital NHS Foundation Trust, London, UK ,grid.83440.3b0000000121901201UCL Institute of Ophthalmology, London, UK ,grid.424537.30000 0004 5902 9895Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rose Gilbert
- grid.436474.60000 0000 9168 0080Moorfields Eye Hospital NHS Foundation Trust, London, UK ,grid.83440.3b0000000121901201UCL Institute of Ophthalmology, London, UK ,grid.24029.3d0000 0004 0383 8386Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Helbig C, Wollny A, Altiner A, Diener A, Kohlen J, Ritzke M, Frech S, Guthoff RF. Treatment Complexity in Primary Open-Angle Glaucoma (POAG): Perspectives on Patient Selection in Micro-Invasive Glaucoma Surgery (MIGS) Using Stents. Klin Monbl Augenheilkd 2020; 238:302-310. [PMID: 33254258 DOI: 10.1055/a-1241-4489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Primary open-angle glaucoma (POAG) is still one of the most common causes of impaired vision worldwide, despite the further development of therapy options, and can lead to blindness. Micro-invasive glaucoma surgery (MIGS) using stents aims at reducing intraocular pressure (IOP), as it is the main risk factor. With regard to adherence and adverse drug reactions it also aims at reducing the drug burden on patients. The study investigates under everyday conditions the criteria according to which ophthalmologists in Germany select patients for MIGS using stents. In addition, it will be investigated which patients (could) benefit most from the therapy. MATERIAL AND METHODS In this qualitative study, 11 narrative interviews were conducted between May 2017 and July 2018 with ophthalmologists working in the hospital or in a private practice. They were interviewed on their experiences in the treatment of POAG with microstents. The interviews were analysed by an interdisciplinary team using the qualitative content analysis. RESULTS The stages of therapy escalation form the frame of reference for patient selection in MIGS using stents. Only if the IOP cannot be sufficiently reduced by drop therapy or when this causes drug-related side effects that are intolerable for the patients, stents are apparently used as the next higher escalation stage. The intensive post-operative medication and the frequent check-up appointments are perceived as barriers by the interviewees, especially for people with or without disabilities, who are dependent on external help and/or those living in rural areas. The active cooperation of the patients in the demanding aftercare seems to be indispensable for the ophthalmologists. In addition, necessary revisions are sometimes stressful for patients (physical/psychological) and doctors (work organisation/therapy). Against the background of the organisational and economic challenges in the outpatient spectrum of tasks, especially physicians in private practice seem to weigh up carefully for which patients microstent therapy would be reasonable. CONCLUSION In view of the therapeutic requirements, the current microstent therapy seems to be used in a selected, adherent patient group. Further qualitative and quantitative studies (in other health care regions and structures) are necessary to verify and extend the available results.
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Affiliation(s)
- Christian Helbig
- Institute of General Medicine, University Medicine Rostock, Germany
| | - Anja Wollny
- Institute of General Medicine, University Medicine Rostock, Germany
| | - Attila Altiner
- Institute of General Medicine, University Medicine Rostock, Germany
| | - Annette Diener
- Institute of General Medicine, University Medicine Rostock, Germany
| | - Juliane Kohlen
- Institute of General Medicine, University Medicine Rostock, Germany
| | - Manuela Ritzke
- Institute of General Medicine, University Medicine Rostock, Germany
| | - Stefanie Frech
- Clinic and Polyclinic for Ophthalmology, University Medicine Rostock, Germany
| | - Rudolf F Guthoff
- Clinic and Polyclinic for Ophthalmology, University Medicine Rostock, Germany
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Taylor DJ, Jones L, Binns AM, Crabb DP. 'You've got dry macular degeneration, end of story': a qualitative study into the experience of living with non-neovascular age-related macular degeneration. Eye (Lond) 2020; 34:461-473. [PMID: 31118490 PMCID: PMC7042256 DOI: 10.1038/s41433-019-0445-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/25/2019] [Accepted: 04/04/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/OBJECTIVES To investigate the impact of non-neovascular (dry) age-related macular degeneration (AMD) on the person with respect to diagnosis, vision loss and coping strategies. SUBJECTS/METHODS Volunteers with dry AMD with a range of disease severity were given an eye examination and asked to describe aspects of their experience with dry AMD in a semi-structured interview. Interviews were audio-recorded, transcribed, and subjected to Framework analysis. Overarching themes were pre-defined, whilst subthemes were derived from the data. RESULTS Twenty-seven participants (81% female), with early (n = 3), intermediate (n = 16) and advanced dry AMD (GA; n = 8) were interviewed. Median (interquartile range) age (years), logMAR binocular visual acuity and Pelli-Robson contrast sensitivity were 76 (71, 80), 0.2 (0.18, 0.40) and 1.65 (1.35, 1.93), respectively. Overarching themes (and subthemes) were: diagnosis (relationship with healthcare professional, psychological impact of diagnosis, and knowledge of AMD, both pre- and post-diagnosis), impact of visual loss (functional and psychological) and coping strategies (help from others and personal strategies). Many participants reported feelings of distress at the time of diagnosis and, particularly noteworthy, several reported a constant fear of their condition worsening. CONCLUSIONS Dry AMD, for which there is currently no treatment, can have a significant impact on individuals, even in its early stages, before significant functional vision loss is manifest, as well as in its intermediate and advanced stages. Results from this study offer important insight into the experience of living with dry AMD not previously explored. Moreover, the results have the potential to serve as an educational resource for eyecare professionals.
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Affiliation(s)
- Deanna J Taylor
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Lee Jones
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Alison M Binns
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK.
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