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Solebo A.L.,University College London | Rahi J.,University College London | Rahi J.,Great Ormond Street Biomedical Research Center | Rahi J.,Moorfields Biomedical Research Center
Archives of Disease in Childhood

An estimated 19 million of the world's children are visually impaired, while 1.4 million are blind. Using the UK as a model for high income countries, from a population-based incidence study, the annual cumulative incidence of severe visual impairment/blindness (SVL/BL) is estimated to be 6/10 000 by age 15 years, with the incidence being highest in the first year of life. The population of visually impaired children within high, middle and lower income countries differ considerably between and within countries. The numerous and mainly uncommon disorders which can cause impaired vision result in heterogeneous population which includes a substantial proportion (for SVI/BL, the majority) of children with additional systemic disorders or impairments whose needs differ substantially from those with isolated vision impairment. Paediatricians and other paediatric professionals have a key role in early detection and multidisciplinary management to minimise the impact of visual impairment (VI) in childhood. Source

Mathew R.,Kings College | Bafiq R.,Kings College | Ramu J.,Kings College | Pearce E.,Kings College | And 6 more authors.
British Journal of Ophthalmology

Aim: To evaluate spectral domain optical coherence tomography (SD-OCT) changes in central retina and choroid in patients with sickle cell disease (SCD). Methods: Data on visual acuity, severity of sickle cell retinopathy, macular volume scans and choroidal thickness on SD-OCT were analysed from 208 eyes of 107 consecutive patients referred for screening for SCD. The retinal and choroidal thickness of eyes with SCD were also compared with age and ethnicity matched controls. Results: 44% of the eyes of patients with SCD showed discrete areas of retinal thinning in the temporal macular area. Proliferative sickle cell retinopathy was more prevalent in these eyes compared with SCD eyes with normal macular morphology (67% vs 48%; p=0.0017). The temporal total and inner retinal thickness, macular volume and choroidal thickness were significantly lower in patients with SCD compared with age, gender and ethnicity matched controls. Macular splaying (widening of the macular contour) was noted in 30% of eyes in both groups. The choroidal and retinal thickness values showed good intergrader reliability using weighted κ statistics (0.550-0.9). Conclusions: Quantitative and qualitative changes on SD-OCT are present in asymptomatic SCD eyes. Proliferative retinopathy is more prevalent in eyes with discrete areas of macular thinning. Source

Smith R.L.,University of Sao Paulo | Sivaprasad S.,Moorfields Biomedical Research Center | Chong V.,University of Oxford
Developments in Ophthalmology

The vitreous, the vasculature of the retina, macular pigments, phototransduction, retinal pigment epithelium, Bruch's membrane and the extracellular matrix, all play an important role in the normal function of the retina as well as in diseases. Understanding the pathophysiology allows us to target treatment. As ocular angiogenesis, immunity and inflammation are covered elsewhere, those subjects will not be discussed in this chapter. © 2016 S. Karger AG, Basel. Source

Butt T.,University College London | Dunbar H.M.P.,University College London | Morris S.,University College London | Orr S.,University College London | And 2 more authors.
Optometry and Vision Science

PURPOSE: Health utility values suitable for calculating quality-adjusted life-years are increasingly used to assess the cost-effectiveness of treatments for age-related macular degeneration (AMD). In the United States, health utilities are usually derived from the patients' own valuation or modeled using visual acuity as a surrogate outcome. In the United Kingdom and throughout Europe, health utilities are derived from public valuations. Our aim was to test if utility values for health states associated with AMD elicited directly from patients were different from those calculated from public tariffs for health-related quality of life (HRQoL) questionnaires. METHODS: Generic preference-based HRQoL questionnaires (EQ-5D and SF-6D) and the time trade-off (TTO) and visual analog scale (VAS) valuation techniques were administered to a sample of UK patients with AMD (N = 60). Health utilities were calculated using standard general population tariffs for the patient EQ-5D and SF-6D health states and directly from patient TTO and VAS scores. RESULTS: Mean utilities derived from the public tariffs were significantly higher than from patients' valuation (mean [±SD], 0.613 (±0.275) for the EQ-5D and 0.628 (±0.114) for the SF-6D compared with 0.481 [±0.411] for the TTO and 56.7 [±21.8] for the VAS score; p < 0.001). The EQ-5D was not significantly different from the SF-6D (p > 0.6). Visual acuity in the better seeing eye was not associated with any utility measure (all r < 0.08; p > 0.2). CONCLUSIONS: Patient and public preferences for health states associated with AMD are different, with patients valuing their health state more severely than the public tariffs of commonly used HRQoL questionnaires. Visual acuity did not predict health utility using any measure, and therefore, care should be taken when using visual acuity as a surrogate measure for utility in health economic analyses. © 2013 American Academy of Optometry. Source

Wong T.Y.,Singapore Eye Research Institute | Ohno-Matsui K.,Tokyo Medical and Dental University | Leveziel N.,University of Monastir | Holz F.G.,University of Bonn | And 5 more authors.
British Journal of Ophthalmology

Choroidal neovascularisation (CNV) is a common visionthreatening complication of myopia and pathological myopia. Despite significant advances in understanding the epidemiology, pathogenesis and natural history of myopic CNV, there is no standard definition of myopic CNV and its relationship to axial length and other myopic degenerative changes. Several treatments are available to ophthalmologists, but with the advent of new therapies there is a need for further consensus and clinical management recommendations. Verteporfin photodynamic therapy has been an established treatment for subfoveal myopic CNV for many years, but this treatment does not restore visual acuity and is associated with long-term chorioretinal atrophy. More recently, clinical trials investigating the efficacy and safety of anti-vascular endothelial growth factor agents in patients with myopic CNV have demonstrated substantial visual acuity gains and quality of life increases compared with photodynamic therapy. These enhanced outcomes provide updated evidence-based clinical management guidelines of myopic CNV, and increase the need for a generally accepted definition for myopic CNV. This review critically summarises the latest myopic CNV literature in the context of clinical experience and recommends a myopic CNV treatment algorithm. Source

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