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Papaioannou C, Maubon L, Kirkpatrick B. Prospective interviews to understand patient attitudes towards digitalisation of clinic in medical ophthalmology: a quality improvement project. Future Healthc J 2023; 10:110-111. [PMID: 38406756 PMCID: PMC10884626 DOI: 10.7861/fhj.10-3-s110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
| | - Laura Maubon
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Laviers H, Papavasileiou E, Bruce C, Maubon L, Radia M, Dervenis N, Zuckerman B, Loh GK, Theodorou O, Douiri A, Zambarakji H, Sandinha T, Steel DH, Kirthi V, McKechnie C, Zakir R, Duguid G, Jackson TL. The effect of ethnicity on anatomic success following macular hole surgery: a multicentre cohort study. Graefes Arch Clin Exp Ophthalmol 2023; 261:1535-1543. [PMID: 36602644 DOI: 10.1007/s00417-022-05950-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/29/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The purpose is to assess the effect of ethnicity on surgical macular hole closure. METHODS A retrospective cohort study was undertaken in five UK National Health Service Hospitals. We included all patients with known ethnicity undergoing vitrectomy, internal limiting membrane peel, and gas/oil tamponade for all stages of primary full-thickness macular hole (FTMH). The primary outcome was anatomic success, defined as FTMH closure with one operation. The secondary outcome was mean change in best-corrected visual acuity (BCVA) comparing baseline with final review. RESULTS Of 334 operations, the ethnicity profile comprised 78.7% White patients, 11.7% Black patients, 8.1% Asian patients, and 1.5% in mixed/other ethnicities. Mean age was 69.7 years with 68.5% females. Overall, 280 (83.8%) had anatomic success. Anatomic failure occurred in 38.5% of Black patients versus 12.6% of White patients (relative risk: 1.788; 95% CI: 1.012 to 3.159; P = 0.045). Overall, baseline logarithm of the minimum angle of resolution BCVA improved by 0.34, from 0.95 (95% CI: 0.894 to 1.008) to 0.62 (95% CI: 0.556 to 0.676). Mean BCVA improved by 0.35 in White patients, 0.37 in Black patients, 0.23 in Asian patients, and 0.38 in mixed/other ethnicity (P = 0.689). Greater FTMH minimum linear diameter was associated with an increased risk of anatomic failure (relative risk: 1.004; 95% CI: 1.002 to 1.005; P < 0.0001), whereas better pre-operative BCVA (F [1,19] = 162.90; P < 0.0001) and anatomic success (F [1,19] = 97.69; P < 0.0001) were associated with greater BCVA improvement. Socio-economic status did not significantly influence anatomic success or BCVA change. CONCLUSIONS Black ethnicity is associated with an approximately twofold greater risk of failed FTMH surgery. The reasons for this difference warrant further study.
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Affiliation(s)
- Heidi Laviers
- Moorfields Duke Elder Eye Unit, St. George's University Hospitals NHS Foundation Trust, SW17 0QT, London, UK.
| | | | | | - Laura Maubon
- Department of Ophthalmology, Kings College Hospital NHS Foundation Trust, London, UK
| | - Meera Radia
- The Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Foundation Trust, London, UK
| | - Nikolaos Dervenis
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Benjamin Zuckerman
- Department of Ophthalmology, Kings College Hospital NHS Foundation Trust, London, UK
| | | | | | - Abdel Douiri
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Hadi Zambarakji
- The Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Foundation Trust, London, UK
| | - Teresa Sandinha
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - David H Steel
- Sunderland Eye Infirmary, NHS Trust, Sunderland, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Varo Kirthi
- Department of Ophthalmology, Kings College Hospital NHS Foundation Trust, London, UK
- Faculty of Life Science and Medicine, King's College London, London, UK
| | - Cordelia McKechnie
- The Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Foundation Trust, London, UK
| | - Rahila Zakir
- Western Eye Hospital, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | | | - Timothy L Jackson
- Department of Ophthalmology, Kings College Hospital NHS Foundation Trust, London, UK
- Faculty of Life Science and Medicine, King's College London, London, UK
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Ong ZZ, Henein C, Swampillai AJ, Maubon L, Bourne RRA, Ting DSJ. Trainee research network (TRN): a potential global model for promoting research training and outputs among trainees. Eye (Lond) 2022; 36:2358-2360. [PMID: 35422495 PMCID: PMC9008609 DOI: 10.1038/s41433-022-02060-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 01/17/2023] Open
Affiliation(s)
- Zun Zheng Ong
- grid.415598.40000 0004 0641 4263Department of Ophthalmology, Queen’s Medical Centre, Nottingham, UK
| | - Christin Henein
- grid.83440.3b0000000121901201Institute of Ophthalmology, University College London, London, UK ,grid.83440.3b0000000121901201National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Andrew J. Swampillai
- grid.419309.60000 0004 0495 6261West of England Eye Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter, Devon UK
| | - Laura Maubon
- grid.425213.3Department of Ophthalmology, St. Thomas Hospital, London, UK
| | - Rupert R. A. Bourne
- grid.5115.00000 0001 2299 5510Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK ,grid.24029.3d0000 0004 0383 8386Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK ,grid.451056.30000 0001 2116 3923National Institute for Health Research (NIHR) Clinical Research Network, Cambridge, UK
| | - Darren S. J. Ting
- grid.415598.40000 0004 0641 4263Department of Ophthalmology, Queen’s Medical Centre, Nottingham, UK ,grid.4563.40000 0004 1936 8868Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
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Maubon L, Sibley D, Thaung C, Vasquez-Perez A. Comment on Mucopolysaccharidosis Type I-Associated Corneal Disease: A Clinicopathologic Study. Am J Ophthalmol 2022; 235:332-333. [PMID: 34715078 DOI: 10.1016/j.ajo.2021.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/01/2022]
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Swampillai AJ, Nowak VA, Maubon L, Neffendorf JE, Sahota D, Williams O, Lakhani B, Soare C, Sychev I, Ridyard E, Patel PJ, Park JC. Confidence of UK Ophthalmology Registrars in Managing Posterior Capsular Rupture: Results from a National Trainee Survey. Ophthalmol Ther 2021; 11:225-237. [PMID: 34799828 PMCID: PMC8770778 DOI: 10.1007/s40123-021-00425-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction To establish the level of confidence amongst UK ophthalmology specialist registrars (residents) in managing posterior capsule rupture (PCR) during cataract surgery. Methods An online nine-item questionnaire was distributed to all registrars, recruited nationwide via regional representatives. Data collected included stage of training, number of completed cataract operations, cumulative PCR rate, number of PCRs independently managed, understanding of vitrectomy settings and fluidic parameters and access to simulation. Respondents self-evaluated their confidence in managing PCR with vitreous loss. Results Complete responses were obtained from 248 registrars (35% response rate). Mean number of phacoemulsification procedures performed was 386. For senior registrars (OST 6–7), 35 out of 70 (50%) felt confident to manage PCR independently and 55 out of 70 (78.6%) were either quite confident or very confident at deciding when to implant an intraocular lens during PCR management. Lower confidence levels were noted for junior trainees (OST 1–2). Over 65% of survey respondents had access to relevant simulation. Conclusions Our results represent the largest UK survey analysing the confidence of PCR management amongst registrars. Confidence improves with duration of training and increased exposure to management of PCR. However, 50% of senior registrars still lacked confidence to independently manage PCR and vitreous loss. A specific competency-based framework, potentially using a simulator or simulating a PCR event, incorporated into the curriculum may be desirable.
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Affiliation(s)
- Andrew J Swampillai
- Department of Ophthalmology, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, Somerset, UK
| | | | | | | | | | | | | | | | | | | | - Praveen J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Jonathan C Park
- Department of Ophthalmology, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, Somerset, UK.
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Maubon L, Nderitu P, O'Brart DPS. Returning to cataract surgery after a hiatus: a UK survey report. Eye (Lond) 2021; 36:1761-1766. [PMID: 34363047 PMCID: PMC8343362 DOI: 10.1038/s41433-021-01717-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/08/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives Cataract surgeons may periodically take time away from operating which can lead to skills fade. There is a paucity of research investigating the experiences of returning cataract surgeons and how different individual circumstances impact on their return. Our aim was to investigate the subjective experiences of UK ophthalmologists simultaneously returning to surgery following the nationwide elective surgical hiatus due to the Covid-19 pandemic. Methods An online survey was nationally distributed between 01/09/2020 and 29/10/2020 to registered UK ophthalmologists. Participants indicating a surgical hiatus of 8 weeks or more were included. Results 232 of 264 responses were analysed. Covid-19 was the most frequent reason for a surgical hiatus (median 15 weeks). Perceived operating difficulties were found in 29.1%. Transient anxiety (51.7%), reduced confidence, and perceived increased surgical time were commonplace. Trainees and females were more likely to encounter negative experiences (p < 0.001) and barriers to resource accessibility. Eyesi® and online videos were the most available and accessed pre-return resources. Childcare was five times more likely to present as a barrier to resource access for females than males. Conclusions Technical skills fade such as capsulorhexis difficulties were commonly perceived by trainee surgeons in addition to transient anxiety, reported in more than half of all surgeons following a hiatus as short as 8 weeks. Eyesi® simulation offers the potential to negate technical de-skilling. Few had formal return plans or awareness of RCOphth guidance. We believe there is scope for more specialised and targeted support for future returning cataract surgeons thereby optimising patient care.
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Affiliation(s)
- Laura Maubon
- Guy's and St Thomas' NHS Foundation Trust, London, UK. .,Moorfields Eye Hospital NHS Foundation Trust, London, UK.
| | - Paul Nderitu
- King's College Hospital, NHS Foundation Trust, London, UK
| | - David P S O'Brart
- Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
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Narang U, Maubon L, Shah V, Wagh V. Ocular trauma or Oedipism: completing the evisceration. GMS Ophthalmol Cases 2021; 11:Doc13. [PMID: 34540525 PMCID: PMC8422941 DOI: 10.3205/oc000186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Self-enucleation, also known as Oedipism, is a rare form of ocular trauma. The objective of this clinical case report is to highlight the importance of diagnosing this unusual injury and thus ensuring its appropriate management. We herein describe a case of a 58-year-old man who presented to hospital with a bleeding left eye. Initially, limited history was provided, however, on further enquiry it was revealed that he had paranoid schizophrenia. The patient eventually had to be sectioned with assistance from the Police and Psychiatry team, upon discovery of self-inflicted mechanism of injury. Subsequently, the patient had evisceration of the left eye and afterwards, demonstrated insight into the pre-operative problems. Literature review emphasizes the importance of close cooperation required between medical specialities to ensure that the underlying cause, usually schizophrenia, is managed in conjunction to the eye injury in order to provide optimum care for the patient.
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Affiliation(s)
- Ujjwala Narang
- St. George’s, University of London, United Kingdom,*To whom correspondence should be addressed: Ujjwala Narang, St. George’s, University of London, Cranmer Terrace, SW17 0RE, London, United Kingdom, E-mail:
| | | | - Vishal Shah
- King’s College Hospital, London, United Kingdom
| | - Vijay Wagh
- St. Thomas’ Hospital, London, United Kingdom
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Shah V, Naderi K, Maubon L, Jameel A, Patel DS, Gormley J, Heemraz S, Azan E, Verma S, Low S, O'Brart D. Acceptability of immediate sequential bilateral cataract surgery (ISBCS) in a public health care setting before and after COVID-19: a prospective patient questionnaire survey. BMJ Open Ophthalmol 2020; 5:e000554. [PMID: 34192150 PMCID: PMC7482101 DOI: 10.1136/bmjophth-2020-000554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/14/2020] [Accepted: 08/28/2020] [Indexed: 01/19/2023] Open
Abstract
Objective To ascertain patient acceptance of immediate sequential bilateral cataract surgery (ISBCS) in the National Health Service (NHS). Methods A survey was devised using a 5-point Likert scale for questions related to ISBCS, which patients undertook during their cataract outpatient appointment pre-COVID-19 lockdown and by telephone during the lockdown. Results Questionnaires were completed for 267 patients. Most respondents were aged over 71 (51%) and were female individuals (60%). Forty-five per cent agreed/strongly agreed with opting for ISBCS. A positive correlation was identified between opting for ISBCS and convenience to the patient (r=0.76, p<0.01) and family/carer/partner (r=0.71, p<0.01) and wanting to limit numbers of hospital visits (r=0.57, p<0.01). Fifty per cent agreed/strongly agreed that they were worried about the risk of simultaneous bilateral ocular complications, with this correlating with being less likely to opt for ISBCS (r=-0.49, p<0.01) and being scared of ISBCS (r=0.67, p<0.01). During COVID-19 lockdown, patients were less likely to want to minimise the time taken off work (p<0.05) and less intolerant of a prolonged hospital visit (p<0.05). Only 23% of respondents agreed/strongly agreed that they had familiarity with ISBCS. Conclusions ISBCS was acceptable to 45% of our sampled population, suggesting limited routine implementation in the NHS is possible. Convenience and reduction in hospital visits appeared to contribute to this acceptance. Half of the patients expressed concern regarding bilateral complications and such concerns need addressing. Some attitudes did appear to change during the COVID-19 lockdown period. The familiarity of the concept of ISBCS is low suggesting the need for patient education.
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Affiliation(s)
- Vishal Shah
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Khayam Naderi
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Laura Maubon
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ashmal Jameel
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Darshak S Patel
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jack Gormley
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sanjeev Heemraz
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Elodie Azan
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Seema Verma
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sancy Low
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David O'Brart
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
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Affiliation(s)
- L Maubon
- Epsom and St Helier University Hospitals NHS Trust, Surrey, UK
| | - N Hirji
- Epsom and St Helier University Hospitals NHS Trust, Surrey, UK
| | - R Petrarca
- Epsom and St Helier University Hospitals NHS Trust, Surrey, UK
| | - P Ursell
- Epsom and St Helier University Hospitals NHS Trust, Surrey, UK.,The Royal Marsden Hospital, London, UK
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Michalarea V, de Miguel Luken MJ, Diamantis N, Garg A, Maubon L, Yap TA, Molife LR, De Bono JS, Ursell P, Banerji U. Ocular toxicity with MEK inhibitors in phase I trials: A single centre experience across six clinical trials. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.11090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vasiliki Michalarea
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - Nikolaos Diamantis
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Surrey, United Kingdom
| | - Anurag Garg
- Epsom and St. Helier NHS Trust, Epsom, United Kingdom
| | - Laura Maubon
- Epsom and St. Helier NHS Foundation Trust, Epsom, United Kingdom
| | - Timothy Anthony Yap
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Johann Sebastian De Bono
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Paul Ursell
- Epsom & St. Helier NHS Trust / The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
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