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A review of evidence to evaluate effectiveness of intervention strategies to address inequalities in eye health care

Annex A: Summary reference table

Date: December 2011

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This annex accompanies the report: A review of evidence to evaluate effectiveness of intervention strategies to address inequalities in eye health care, RNIB report: RNIB/CEP/01, 2011. To accommodate formatting constraints, the font used in this annex may not be fully accessible. A large print version of the annex is available on request.

Atri J, Falshaw M, Gregg R, Robson J, et al. (1997). Improving uptake of breast screening in multiethnic populations: a randomised controlled trial using practice reception staff to contact non-attenders. British Medical Journal. Vol. 315, pp. 1356-9.Study Purpose & Type

Sample Characteristics

Intervention Outcome Measures

Results Conclusions Quality

A controlled trial randomised by general practice to determine whether a two hour training programme for general practice reception staff could improve uptake in patients who had failed to attend for breast screening, and whether women from different ethnic groups benefited equally

2,064 women aged 50-64 years who came from 26 general practices in the inner London borough of Newham, 31% were white, 17% were Indian, 10% Pakistani, 14% black, 6% Bangladeshi, 1% Chinese, 4% were from other ethnic groups, and in 16% the ethnic group was not reported

Intervention group: Training programme for a member of reception staff at a general practice.Control group: No training programme for reception staff

Attendance for breast screening in relation to ethnic group in women who had not taken up their original invitation

Attendance in the intervention group was significantly better than in the control group with the best response coming from Indian women

Train front line staff and use telephone calls to remind people called for screening. This intervention could be effective as part of a multifaceted strategy to improve uptake in areas with low rates

Strong but indirect as does not focus on vision

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Access Economics (2009) Future sight loss UK (1): The economic impact of partial sight and blindness in the UK adult population. Report prepared for RNIB by Access Economics Pty Limited, July 2009. Study Purpose & Type




Epidemiological estimates of the numbers of people likely to have age-related macular degeneration (AMD), cataract, diabetic retinopathy (DR) and glaucoma at two points in time, 2010 and 2020

Estimated costs to society of the resources used in health and social service and in providing informal care in that time frame

A ‘System Dynamics’ model to simulate the dynamics of eye disorders in large populations

The ‘system’ comprises the given population and the health care and related resources therein

n/a Estimates of the numbers of the prevalence of age-related macular disease, cataract, diabetic retinopathy and glaucoma

The baseline and cumulative costs to society of the prevailing health and social care provision

AMD: in 2010, 223,224 people partially sighted or blind. In 2020, figure is 291,982

Cataract: number of operations in 2010 more than 389,000. rising to 473,944 in 2020

DR: in 2010, 65,958 people partially sighted or blind. In 2020, figure is 76,430

Glaucoma: in 2010, 75,157 people partially sighted or blind. In 2020, figure is 75,157

Authors observed that a more robust information base is required

The serious deficit in reliable information on levels of detection and treatment coverage for eye conditions limits the output of this decade model at present

Fit for purpose.

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Acharya N, Lois N, Townend J, Zaher S, Gallagher M, Gavin M (2009) Socio-economic deprivation and visual acuity at presentation in Exudative age-related macular degeneration. Br J Ophthalmol, 93: 627-629. Study Purpose & Type




Study to evaluate the influence of socio-economic factors on visual acuity (VA) at presentation in exudative age-related macular degeneration (AMD)

All consecutive patients with newly diagnosed exudative AMD examined at the Ophthalmology Departments of two hospitals in Scotland, between July 2004 and June 2005 (n = 240)

n/a Ophthalmic: VA in study and fellow eye, exudative AMD characteristics; and status of fellow eye

Demographics; duration of symptoms; and patient home address, to determine the Scottish Index of Multiple Deprivation (SIMD) score

Age, location and type of the choroidal neovascularisation were statistically significantly associated with VA at presentation

SIMD scores, area and VA in the fellow eye were not associated with presenting vision

Age, location and type of choroidal neovascularisation, but not socio-economic deprivation, were associated with VA at presentation in exudative AMD

Fit for purpose

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AREDS (2001) A Randomized, Placebo-Controlled, Clinical Trial of High-Dose Supplementation With Vitamins C and E, Beta Carotene, and Zinc for Age-Related Macular Degeneration and Vision Loss: AREDS Report No. 8’ (Age-Related Eye Disease Study Research Group). Arch Ophthalmol, 119: 1417-1436.Study Purpose & Type




A randomized, placebo-controlled study to evaluate the effect of high-dose vitamins C and E, beta carotene, and zinc supplements on AMD progression and visual acuity

Participants aged 55 to 80 enrolled into 11 retinal specialty clinics between the years 1992 and 1998 (n = 3640)

Participants were randomly assigned to receive daily oral tablets containing: (1) antioxidants (vitamin C, 500 mg; vitamin E, 400 IU; and beta carotene, 15 mg); (2) zinc, 80 mg, as zinc oxide and copper, 2 mg; (3) antioxidants plus zinc; or (4) placebo

Photographic assessment of progression to or treatment for advanced AMD

Moderate visual acuity loss from baseline (> or =15 letters)

Estimates of odds ratios (ORs) for specified outcomes

Versus placebo, statistically significant odds reduction for the development of advanced AMD with antioxidants plus zinc

Both zinc and antioxidants plus zinc significantly reduced the odds of developing advanced AMD in the higher-risk group

Persons older than 55 years should have dilated eye examinations to determine their risk of developing advanced AMD

Those with extensive intermediate size drusen, at least 1 large druse, or advanced AMD should consider taking a supplement of antioxidants plus zinc

Strong

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Awobem JF, Cassels-Brown A, Buchan JC, Hughes KA (2009) Exploring glaucoma awareness and the utilization of primary eye care services: community perceived barriers among elderly African Caribbeans in Chapeltown, Leeds. Eye, 23(1): 243.Study Purpose & Type




Community-based qualitative study conducted in fulfilment of a Masters in Public Health Dissertation to explore knowledge and attitudes concerning glaucoma and investigate the utilisation and barriers to uptake of primary eye care

Members of the Black African-Caribbean community living in a large city in Northern England (n = 16)

n/a Knowledge and attitudes concerning access to primary eye care services (PECS)

Utilisation of PECS was largely symptom driven

Once attendance is established, optometrist letters a substantial incentive for attendance (50% of respondents)

Family members most important source of info about glaucoma (87%)

Barriers to PECS include perceived cost of eye tests (37%); mistrust (31%); pressure to buy expensive glasses (37%)

Initiatives to overcome attitudinal barriers to the uptake of PECS are necessary from the service user and the provider perspective

Fair/weak

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Baker H, Murdoch IE. (2004). Can a public health package on glaucoma reach its target population? Eye. Vol. 18, pp. 478-82.Study Purpose & Type




A pilot study to assess how successful a newspaper advertisement and a radio interview about glaucoma are at reaching their target population

A convenience method of sampling used for residents aged 45+ years living in either Southall, London or on the Isle of Wight

Participants were approached in the high street and local temples in Southall, London and in the town centre of Newport, Isle of Wight

An interview on local radio and an advertisement in the local newspaper

A questionnaire administered pre and post intervention

Questionnaire in Hindi for residents of Southall, London and in English for residents of Isle of Wight

Statistical analysis of survey data

Participants who had heard of glaucoma increased from 54% before the intervention to 60% after. Those who had heard of the disease increased by 13% in Southall (SA sample) from lower baseline and by 8% on the Isle of White

Newspaper advert was effective in both areas but radio interview only affected residents of Southall, London

Media work differently for different groups / locations

Further research is required to determine the best method of reaching target populations through radio. Other media may need to be considered

Fit for purpose

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Baker H, Murdoch IE. (2008). Can a public health intervention improve awareness and health-seeking behaviour for glaucoma? British Journal of Ophthalmology. Vol. 92, pt. 12.Study Purpose & Type




To investigate whether a public education campaign can increase awareness and change help-seeking behaviour with respect to ocular health in an Indian population

Indian population aged 60+ years living in Southall, Ealing

Health knowledge questionnaire and a health campaign consisting of television advertising, local press, local radio and places of worship

Sight test data collected by local optometric patients 6 months before and after the intervention

After the intervention the majority of participants (69%) heard about glaucoma from local radio rather than from their GP though the study did not show a change in health seeking behaviours

Radio appeared to be the most effective method of reaching target group (Indians aged 60+ years) but had little effect on behaviour

Fit for purpose

UK study

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Bellary S, O'Hare JP, Raymond NT, Gumber A, et al (2008). Enhanced diabetes care to patients of south Asian ethnic origin (the United Kingdom Asian Diabetes Study): a cluster randomised controlled trial. Lancet. 24;371(9626), pp. 1769-76.Study Purpose & Type




Cluster randomised trial investigating the effectiveness of a culturally sensitive, enhanced care package in UK general practices for improvement of cardiovascular risk factors in patients of south Asian origin with type 2 diabetes

1,486 patients at 21 general practices, seven in Coventry (patients = 500) and 14 in Birmingham (patients = 986). General practices were chosen for the high number of south Asian patients they have (80%+)

Nine of the practices received the intervention (n= 868) while 12 were included in the control group (n=618)

Intervention group: Enhanced care including additional time with practice nurse and support from a link worker and diabetes-specialist nurse

Control group: Standard care

Changes in blood pressure, total cholesterol, and glycaemic control (haemoglobin A1c) after 2 years.

Statistical analysis

A comparison of intervention and control groups after 2 years showed significant differences for diastolic blood pressure and mean arterial pressure after adjustment for confounding and clustering

Small but sustained improvements in blood pressure in SA patients can be achieved through a culturally sensitive, enhanced care package. Improvement in glycaemic control remains a major challenge. Further work on health-care delivery in general practice and to improve motivation is needed to reduce health-care inequalities

Strong

UK study

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Burr JM, Mowatt G, Hernández R, Siddiqui MAR, Cook J, Lourenco T, Ramsay C, Vale L, Fraser C, Azuara-Blanco A, Deeks J, Cairns J, Wormald R, McPherson S, Rabindranath K, Grant A (2007) The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation Health Technology Assessment 11,41 Study Purpose & Type




Systematic review to determine if OAC screening meets national criteria for inclusion in NHS national screening programmes

All relevant papers in major electronic databases up to 2005

Screening Evidence of benefit (years of added quality life etc)

No RCTs found nor any consistent evidence of effectiveness although some support that early treatment is desirable

Insufficient evidence to estimate risks in other ethnic groups (non-African descent)

Screening for high risk groups (defined as ‘Black’ ethnic groups and older age groups might be justifiable but at present best practice would be to improve opportunistic case finding through regular attendance at eye health checks

Strong (Systematic review with health economics assessments)

UK study

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Busby D (2004) First Report of the National Eye Care Steering Group London: Department of Health.Study Purpose & Type




First report of the Eye Care Services Steering Group set up in 2002 to develop proposals for modernisation of NHS eyecare, maintaining and developing an integrated, patient-centred service, and improving access, choice, waiting times and quality

Dependent upon original study included in the review

n/a n/a Incidence of visual impairment will rise by approx. 35% by 2020

By age 75, a quarter of all people will have developed a cataract

Prevalence of glaucoma rises from 1-2% >40s, to 5% of >75s

ARMD is the most common cause of irremediable serious visual lossin people over 65 years of age

NHS needs to develop primary care ophthalmic services to meet increased need, particularly from demographic change

Developing partnerships between primary, secondary care and patient will increase access and choice

With training and protocols, primary care could take an enhanced role to benefit of patients and professional development

Fit for purpose

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Chou R, Dana T, Bougatos C (2009) Screening older adults for impaired visual acuity: a review of the evidence for the US Preventive Services Task force (Cochrane review). Annals Internal Medicine, 151: 37-43 and 44-58. Study Purpose & Type




Review of randomized trials and controlled observational studies to update the 1996 U.S. Preventive Services Task Force evidence review on benefits and harms of screening for impaired visual acuity in primary care settings in adults age 65 years or older


Participants from studies that directly evaluated screening for impaired visual acuity in older adults from 1996 to July 2008

n/a Direct evidence on screening and the accuracy of diagnostic tests

Benefits and harms of treatment. Quantitative estimates for treatment effects and relative risks using a random-effects model

Screening for VI in older adults in primary care settings is not associated with improved visual or clinical outcomes

Effective treatment is available for refractive error, cataracts, and AMD

Visual acuity test is standardr screening for vision impairment in primary care, but diagnostic accuracy is uncertain

More research is needed to understand why direct evidence shows no benefits of screening, even though impaired visual acuity is common and effective treatments are available

Strong

Non-UK study so may not be totally transferable

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Claydon BE, Efron N, Woods C (1998) Non-compliance in optometric practice. Ophthal Physiol Opt, 18(2): 187-190. Study Purpose & Type




Review of non-compliance in contact lens behaviour in relation to organisation of optometric practice

n/a – mainly self-citation

n/a n/a n/a Optometric profession should pay attention to compliance issues

weak

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Coleman HR, Chan CC, Ferris FL 3rd, Chew EY. (2008) Coleman, A. L. (1999) Glaucoma. Lancet 354 (9192), 1803-1810.Study Purpose & Type




Review of the knowledge related to the diagnosis, screening, aetiology and risk factors, and management of glaucoma


n/a Dependent upon original study included in the review

Various


Worldwide prevalence of POAG and PCAG will continue to increase

Glaucoma detection should be more aggressive

Burden of POAG and PCAG falls on patients, but also on society

Information might highlight need for periodic eye examinations among individuals with family history

Fit for purpose

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Coleman HR, Chan CC, Ferris FL 3rd, Chew EY. (2008) Age-related macular degeneration. Lancet, 22, 372 (9652): 1835-45.Study Purpose & Type




Review of the literature related to the epidemiology, risk factors, pathophysiology, and management of age-related macular degeneration (AMD)


Various

Mainly dietary supplementation, and vascular endothelial growth factor (VEGF) inhibitors

Various

Development of AMD

Modifiable risk factors

Various


AMD is leading cause of blindness in elderly people of western descent

Most common risk factors are age and cigarette smoking

Treatment with antioxidant vitamins and zinc can reduce the risk of developing AMD by a quarter in those at least at moderate risk

Intravitreal ranibizumab can stabilise vision loss and may improve vision

Fit for purpose

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http://www.ncbi.nlm.nih.gov/pubmed/19027484

Congdon N, Vingerling JR, Klein BE, West S, Friedman DS, Kempen J, O'Colmain B, Wu SY, Taylor HR; Eye Diseases Prevalence Research Group (2004). Prevalence of cataract and pseudophakia/aphakia among adults in the United States. Archives of Ophthalmology, 122(4): 487-94.Study Purpose & Type




To determine the prevalence of cataract and prior cataract surgery (pseudophakia/ aphakia) in the United States and to project the expected change in these prevalence figures by 2020

Dependent upon original study: Black, white and Hispanic persons with cataract or pseudophakia/ aphakia

Seven studies (n = approx 50,000), Barbados Eye Study; Beaver Dam Eye Study; Blue Mountains Eye Study; Melbourne Vision Impairment Project; Proyecto Vision Evaluation Research; Rotterdam Study, Salisbury Eye Evaluation

n/a Estimates of cataract and of pseudophakia/ aphakia, measured in 5-year age intervals starting at 40 years old

Covariates: age and race/ethnicity

Odds ratios (ORs) calculated for relevant variables

Pooled age-specific prevalence figures for cataract increased with age for both black and white persons (P< 0.001)

Women have a significantly (odds ratio=1.37; 95% confidence interval, 1.26-1.50) higher age-adjusted prevalence of cataract

Prevalence of cataract in US did not systematically differ from Australia and Europe

The number of Americans affected by cataract and undergoing cataract surgery will dramatically increase over the next 20 years as the US population ages

Existing data are very poor even in majority groups: more and better research and data collection needed

Fair but major problems of heterogeneity

Non-UK study

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Cook PF, Bremer RW, Ayala A, Kahook MY. (2010). Feasibility of motivational interviewing delivered by a glaucoma educator to improve medication adherence. Clinical Ophthalmology. Vol. 4, pp. 1091–1101.Study Purpose & Type




Randomized trial to ascertain whether motivational interviewing (MI) for patients with glaucoma is feasible in a busy ophthalmology practice

51 patients with primary or secondary open-angle glaucoma prescribed monotherapy topical glaucoma medication from glaucoma clinic at Rocky Mountain Lions Eye Institute, Denver, CO. (USA)

37 participants excluded from the study (less than 80% adherence to treatment)

Twelve patients agreed to take part in RCT

Intervention group (n=8) received standard care with MI while control group (n=4) received standard care

MI training and instruction manual for MI educator, documentation of MI training (education evaluation tools, session records) and state of change rating to measure patient enactment after MI

Statistical analysis using SPSS

Glaucoma educators’ knowledge and delivery of MI improved after training

50% of participants in intervention group completed all MI training sessions

Patients assigned to the intervention group improved over time in both motivation and adherence to medication

MI training is feasible in a busy ophthalmology practice and can be implemented with a standardised training approach

Fit for purpose

Non-UK study

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Cross V, Cragg R, Shah P (2009) Attitudes to patient partnership in the management of African-Caribbean glaucoma. Final Report for the Guide Dogs for the Blind Association (Project Reference 2006-02b). Study Purpose & Type



Results Conclusion Quality

Study of attitudes of users and professionals to patients participation and self-care, and implications for African-Caribbean people living with Glaucoma

32 informants (11 patients, 4 nurses, 5 surgeons, 6 optometrists) and use of Q-sort technique

To enhance self-management strategies

Qualitative sets of typical views, and some health related quality of life estimates

Practitioners had low expectations of patient abilities; patients were perhaps over-confident but willing to engage

Need for more vocal and effective use of community champions and informal dissemination: young A/C patients are at high risk

Fit for purpose

UK study

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Cross V, Shah P, Bativala R, Spurgeon P (2005) Glaucoma Awareness and Perceptions of Risk among African-Caribbeans in Birmingham UK. Diversity in Health and Social Care, 2(2): 81-90.Study Purpose & Type




Qualitative study to explore issues related to glaucoma awareness and perceptions of risk among the African-Caribbean population

African– Caribbean participants who were not receiving treatment from a hospital eye service (n = 48)

n/a Knowledge of glaucoma; glaucoma risk perception and protection motivation; images of blindness; health accounts; cultural context and individual differences

Positive attitude to health promotion does not include eye health

Family history helping individuals to understand how glaucoma might affect them

Attitudes to blindness reflect notion of blind person as victim

Preventative action depends on credibility of both source and nature of information

Study will help practitioners to understand the health beliefs of African–Caribbean patients

Fit for purpose

UK study

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Cross V, Shah P, Bativala R, Spurgeon P (2007) ReGAE 2: Primary Eye Care Service Utilisation and Glaucoma: some viewpoints from African-Caribbeans in Birmingham UK. Eye, 21: 912-920.Study Purpose & Type




A qualitative investigation to identify issues related to utilisation of Primary Eye Care Services (PECS) byAfrican-Caribbean people and consider the implications for enhancing the role of the PECS in glaucoma detection and management

Face-to-face interviews and focus group discussions with members of the African Caribbean community outside the hospital eye-service (n = 48)

n/a PECS utilisation focused on three key areas: access route to the optometrist, causal stimulus for an optometric visit, and experiential accounts of the optometric encounter

Positive attitudes to health promotion existed, but ‘eye health’ was not integral to individuals’ health schemas

The capacity for primary eye care to enhance glaucoma knowledge appeared under utilised and inconsistent

Service delivery undermined by perceived conflicts of interest

Enhancing reciprocalunderstanding between service users andophthalmic practitioners in primary care iscentral to developing flexible, responsive local eye-care services

Fit for purpose

UK study

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Das BN, Thompson JR, Patel R, Rosenthal AR. (1990) The prevalence of age related cataract in the Asian community in Leicester: a community based study. Eye, 4(5): 723-6.Study Purpose & Type




A community based ophthalmic survey to report on the prevalence of the age-related cataract in an Asian Community in the UK and to investigate possible risk factors associated with the disease

Asians and Caucasians (white) aged 40 years and over registered with four inner-city general practitioners in the City of Leicester, England (n = 115 Asians, 119 Caucasians and 6 African Caribbeans)

All cataracts that could be ascribed to congenital or secondary causes were excluded

n/a Ophthalmic: presence of age related cataract

Covariates: age; gender; ethnic origin; racial subgroup; history of smoking; alcohol consumption; diet medication & medical history; and episodes of severe diarrhoea

Prevalence of age-related cataract significantly higher in Asians when compared to (white) Caucasians

Age-related cataract was found to develop earlier in the Asians

A strict vegetarian diet found to be a significant risk factor for age-related cataract in Asian community in Leicester

This population-based study indicates thatthere is a significantly higher prevalence ofage-related cataract in the Asians living in Britain

The findings suggest an earlier onset of the disease in Asians

Repeat analysis will be considered when a larger sample size is available

Fit for purpose

UK study

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http://www.ncbi.nlm.nih.gov/pubmed?term=%22Rosenthal%20AR%22%5BAuthor%5D

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Thompson%20JR%22%5BAuthor%5D

Das BN, Thompson JR, Patel R, Rosenthal AR (1994) The prevalence of eye disease in Leicester: a comparison of adults of Asian and European descent. J R Soc Med, 87(4): 219-22.Study Purpose & Type




Ophthalmic survey to report onthe prevalence of eye disease among adults of Asian and European descent in the UK

People aged 40 years and overregistered withtwo neighbouring inner-city general practices: onepredominantly with Asian patients (n = 173) and the other predominantlywith European patients (n = 204)

n/a Ophthalmic: visualacuity for near and distance; diagnosis of age related cataract, age related macula degeneration, open angle glaucoma and diabetic retinopathy

Covariates: age band; gender; diabetes

Asians had a significantly higher prevalence of age-related cataract

The age of onset of cataract seems earlier in Asians

After adjustment for age, no statistically significant ethnic differences in the prevalence of open-angle glaucoma, macular degeneration or diabetic retinopathy

It is important to both the health services and to scientific research that we continue to monitor eye disease in the British Asian Community to see if the patterns of disease change with time

Fit for purpose

UK study

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Day F, Buchan JC, Cassells-Brown A, Fear J, Dixon R, Wood F (2010) A glaucoma equity profile: correlating disease distribution with service provision and uptake in a population in Northern England, UK. Eye, 24(9): 1478-85. Study Purpose & Type




Equity profile to examine the scale of health inequalities in a population in Northern England, UK

The equity profile was conducted in Leeds, a city in the north of England, with a population of 794,777 in April 2008

n/a Location of general ophthalmic services (GOS) and hospital eye Services

Distribution of glaucoma, known risk factors for glaucoma, and deprivation

Electronic patient record (EPR) data; primary care prescribing data; certifications for visual impairment (CVI); hospital episode statistics; GP with special interest audit data; GOS data; and qualitative data on barriers to uptake

A mismatch between areas of deprivation and location of optometry

Significant association between ‘late presentation’ and older age

Late presentation associated with living in area of high deprivation

Ethnicity data was poorly recorded

Qualitative data provided invaluable insights

Increasing access involves collaboration with optometrists, ophthalmologists, public health, and commissioners

Not acceptable to rely on private high street optometry to provide primary eye care services in areas of high need

Outreach services must be developed and evaluated in areas of relative deprivation if world class eye services are to be achieved

Fit for purpose

UK study

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Demakakos P, Nazroo J Y, Breeze E, Marmot M (2008) Socioeconomic status and health: the role of subjective social status. Social Science and Medicine, 67(2): 330-340.Study Purpose & Type




Cross-sectional data from the second wave (2004–2005) of the English Longitudinal Study of Ageing to examine the link between subjective social status (SSS) and health in old age and investigate whether SSS mediated the associations between objective indicators of socioeconomic status and health

People included in the second wave (2004–2005) oft the English Longitudinal Study of Ageing who reported their SSS (n = 3368 men; 4065 women)

n/a Self-rated health, long-standing illness, depression, hypertension, diabetes, central obesity, high-density lipoprotein cholesterol, triglycerides, fibrinogen, and C-reactive protein.Subjective social status

Covariates: wealth; education; occupational class; age; gender and marital status

In age-adjusted analyses SSS was related positively to almost all health outcomes.Many of relationships remained significant after adjustment for covariates.SSS mediated fully or partially the associations between education, occupational class and self-reported and clinical health measures

SSS is an important correlate of health in old age, possibly because of its ability to epitomize life-time achievement and socioeconomic status

Fit for purpose

UK study

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Desai P. (1993) The National Cataract Surgery Survey: III. Process features. Eye, 7(5): 667–671.Study Purpose & Type




Prospective cross-sectional survey to examine the process of how medical care is provided for cataract patients within the National Health Service

Patients of 50 years of age and over who had surgery for age-related cataract in the UK during the period of the 1990 National Cataract Surgery Survey (n = 975)

n/a Waiting time and level of visual impairment: on presentation at the first out-patient assessment, on listing for surgery and on admission for surgery

Visual acuities; length of stay in hospital, duration of post-operative medication, number of post-op out-patient visits and final refraction

Age-standardised operation rates by region

The majority of patients have considerable levels of visual impairment by the time they present to the hospital eye service

A difference of almost twofold was observed between the lowest and highest regional operation rates, although it must be interpreted with caution

The survey represents the experience of a sample of all patients undergoing surgery for age-related cataract in the UK in 1990

Repeating the survey at regular intervals would provide a practical method of evaluating and auditing surgical practice for national trends in the management of age-related cataract

Fit for purpose

UK study

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Duke SAS, Colagiuri S, Colagiuri R. Individual patient education for people with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD005268. DOI: 10.1002/14651858.CD005268.pub2.Study Purpose & Type




Systematic review to evaluate the effectiveness of individual patient education on metabolic control, diabetes knowledge and psychosocial outcomes


Nine randomised controlled or controlled clinical studies (n = 1359 participants)

Participants were adults diagnosed with type 2 diabetes over the age of 18 years

Individual face-to-face patient education verses usual care, routine treatment or group education

Six studies compared individual education to usual care and three compared individual education to group education

Only studies that assessed outcome measures at least six months from baseline were included

Primary outcomes: metabolic control; diabetes complications; health service utilisation and health care costs

Secondary outcomes: psychosocial outcomes; diabetes knowledge; patient self-care behaviours; physical measures and metabolic measures

Individual face-to-face education did not significantly improve glycaemic control compared with usual care

Individual education had a significant benefit on glycaemic control in patients with a higher mean baseline HbA1c (greater than 8%)

No significant difference in glycaemic control between individual and group education

Benefit exists of individual education on glycaemic control when compared with usual care in those with a baseline HbA1c greater than 8%

Overall, there did not appear to be a significant difference between individual education and usual care

In the small number of studies comparing group and individual education, the impact was equal on HbA1c at 12 to 18 months

Strong

v1.1 Page 25 of 91

Eke T, Reddy MA, Karwatowski WS. (1999). Glaucoma awareness and screening uptake in relatives of people with glaucoma. Eye. Vol. 13, pt. 5.Study Purpose & Type




To assess glaucoma awareness and screening uptake in relatives of people with glaucoma

52 patients with primary open angle glaucoma attending Leicester Royal Infirmary and their relatives (n=90)

n/a Questionnaires for patients and their relatives measuring awareness of glaucoma and available screening services

Analysis of questionnaires returned by relatives of patients (n=70)

53% of relatives felt they were at increased lifetime risk of developing glaucoma, 81% of relatives had been screened but this was infrequently

Siblings of patients with glaucoma had lower awareness of screening services than their offspring

Relatives of people with glaucoma should be made more aware of the need for glaucoma screening and encouraged to use the free screening service

Older relatives should be particularly targeted

Fit for purpose

UK study

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Evans J. (2008). ‘Antioxidant supplements to prevent or slow down the progression of AMD: a systematic review and meta-analysis’. Eye. Vol. 22, pt. 6, pp.751-60. Study Purpose & Type




A systematic review examining the evidence as to whether antioxidant vitamin or mineral supplements prevent the development of Age-Related Macular Degeneration (AMD) or slow down its progression

Dependent upon original studies included in review

A total of 23,099 people were randomised in three trials with treatment duration of 4–12 years for antioxidant supplementation

A total of 4,165 people were randomised in eight trials for antioxidant and zinc supplementation

Antioxidant vitamin and/or mineral supplementation (alone or in combination) to control groups

Ophthalmic: development and progression of age-related maculopathy (ARM ), AMD and loss of vision

Information on adverse events

There was no evidence that antioxidant (vitamin E or β-carotene) supplementation prevented AMD

There was evidence that antioxidant (β-carotene, vitamin C, and vitamin E) and zinc supplementation slowed down the progression to advanced AMD and visual acuity loss in people with signs of the disease

Current evidence does not support the use of antioxidant vitamin supplements to prevent AMD

Strong

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Evans JR, Fletcher AE, Wormald RPL, Siu-Woon Ng E, Stirling S, Smeeth L, Breeze E, Bulpitt CJ, Nunes M, Jones D, Tulloch A (2002) Prevalence of visual impairment in people aged 75 years and older in Britain: results from the MRC Trial of Assessment and Management of Older People in the Community. British Journal of Ophthalmology, 86: 795-800.Study Purpose & Type




Cluster randomised trial to measure the prevalence of visual impairment in a large representative sample of people aged 75 years and over in the UK community

Patients aged 75 years or over at 53 practices in the Medical Research Council general practice research framework (n = 14,600)

All patients aged 75 years or over on the general practitioner list were invited to participate, unless they were in long stay hospital or nursing homes, or were terminally ill

n/a Prevalence of visual impairment (binocular visual acuity <6/18), categorised separately into low vision (binocular visual acuity <6/18–3/60) or blindness (binocular visual acuity of <3/60)

The prevalence of binocular acuity <6/12

Age 75–79, 6.2% visually impaired (5.1% to 7.3%); 36.9% at age 90+ (32.5% to 41.3%)

At age 75–79, 0.6% (0.4% to 0.8%) blind, with 6.9% (4.8% to 9.0%) at age 90+

Women had excess risk of visual impairment (OR 1.43, 95% confidence interval 1.29 to 1.58)

19.9% participants had a binocular acuity of < 6/12 (17.8% to 22.0%)

Visual impairment is common in the older population and this risk increases rapidly with advancing age, especially for women

If visual impairment had been defined as visual acuity of <6/12 (American definition of visual impairment), the age specific prevalence estimates would have increased by 60%

Strong

v1.1 Page 28 of 91

Fraser S, Bunce C, Wormald R, (1999) Risk factors for late attendance of chronic glaucoma. Invest Ophthalmol Vis Sci, 40: 22517Study Purpose & Type




Case– control study to identify the risk factors for having advanced glaucomatous visual field loss on the first visit at hospital eye services

Patients newly diagnosed with glaucoma at first visit to one of three ophthalmic departments in the United Kingdom (n = 220; 110 cases, 110 controls).

Patients with a previous history of ocular hypertension or any documented suspicion of glaucoma (within the hospital eye service) were excluded

n/a Demographic: age when first assessed, sex, ethnic origin, and Standard Occupational Classification

Ophthalmic: coexisting ocular or medical disease, intraocular pressure (IOP) at initial examination, and frequency of sight testing

Estimates of the odds ratios (ORs) of late attendance computed by logistic regression

Occupational group, initial IOP, family history of glaucoma, methodof referral to hospital, and the number of years since the last visit to an optometrist were found to be independently associated with late presentation

Certain subgroups of people with glaucoma are at greater risk of having advanced and irremediable field loss on first visiting the eye services studied

Strong

UK study

v1.1 Page 29 of 91

Fraser S, Bunce C, Wormald R & Brunner, E. (2001). Deprivation and late presentation of glaucoma: case-control study. BMJ. Vol. 322, pt. 7287.Study Purpose & Type




To identify socioeconomic risk factors for first presentation advanced glaucomatous visual field loss

Case-controlled study

220 consecutive patients newly diagnosed with glaucoma at three independent eye hospital departments in England (Moorfields Eye Hospital, London; Sunderland Eye Infirmary, Sunderland; Harold Wood Hospital, Essex)

110 participants were late presenters and 110 participants had early onset glaucoma (control group)

Hospital based case-control study with prospective identification of patients using Jarman's underprivileged area score to classify deprivation and identify socioeconomic factors that influence health seeking behaviours

Unconditional logistic regression was used to measure the effect of each socioeconomic factor on presenting with advanced glaucomatous field damage

Patients who presented with more advanced field loss had higher underprivileged area scores, lower occupational status, and lower education level and were less likely to have access to a car and more likely to be tenants

Presentation with advanced glaucoma is associated with a poor prognosis

Glaucoma should be included among conditions targeted in policy aimed at reducing social inequalities in health

Fit for purpose

UK study

v1.1 Page 30 of 91

Friedman DS, Hahn SR, Gelb L, Tan MS, Shah SN, Kim EE, Zimmerman TJ, Quigley HA. (2008). Doctor-patient communication, health-related beliefs and adherence in glaucoma. Results from the Glaucoma Adherence and Persistence Study. Ophthalmology. Vol. 115, pp. 1320-7. Study Purpose & Type




Retrospective database and chart reviews in combination with prospective patient surveys to determine drivers of patient adherence to topical ocular hypotensive therapy

300 patients with a new claim diagnosis for open-angle glaucoma who initially were prescribed one of three prostaglandins and 103 physicians participating in the same medical plan

n/a

Phone interviews conducted with participating ophthalmologists

Self-reported adherence; experiences with medication; communication with the physician; and health-related beliefs

Medication possession ratio for adherence

Doctor-patient relationship, non-belief in the effects of medication, financial issues, transport difficulties, ethnic minority origin, not receiving reminders from primary care practices were variables associated with lower medication possession ratio

Increased educational efforts by primary care practices may increase glaucoma medication adherence

Fit for purpose

v1.1 Page 31 of 91

Friedman DS, Nordstrom B, Mozaffari E, Quigley HA (2005) Glaucoma management among individuals enrolled in a single comprehensive insurance plan. Ophthalmology, 112(9): 1500-4.Study Purpose & Type




Retrospective cohort study to determine the management patterns for glaucoma and suspect glaucoma in newly treated persons

People enrolled in a commercial health plan in the United Sates between 1995 and 2001 (n = 1712 diagnosed suspects; 3623 diagnosed glaucoma)

Inclusion: 365 days of enrolment before diagnosis; >30 years old when diagnosed; no claim for glaucoma in the 365 days before diagnosis; and no claims for a VF test, fundus photography, or nerve fiber layer imaging in the 12- 2 months before diagnosis

n/a Probability of monitoring (return visits, visual fields (VF), and optic nerve head imaging or photography)

Probability of treatment (argon laser trabeculoplasty (ALT) and surgery) for newly treated persons with suspect and glaucoma diagnoses

Median follow-up was 440 days

Among diagnosed suspects, 83% had a follow- visit to either an optometrist or ophthalmologist. Among diagnosed glaucoma, 84% attended a follow-up visit

Surgery was performed in 1.4% of suspects and 2.1% with diagnosed glaucoma

ALT performed in 6% with diagnosed glaucoma and 2% of diagnosed suspects

Large proportion of individuals requiring treatment are falling out of care and are being monitored at rates lower than expected from recommendations or published guidelines

More research is needed to confirm the findings and to determine the reasons for loss to follow-up and low monitoring rates

Fit for purpose

Non-UK study

v1.1 Page 32 of 91

Friedman DS, Wolfs RCW, O'Colmain BJ, Klein BE, Taylor HR, West S, Leske C, Mitchell P, Congdon N, Kempen J, Tielsch J for the EDPRG (2004), 'Prevalence of open angle glaucoma among adults in the United States'. Archives of Ophthalmology, 122: 532-538.Study Purpose & Type




To estimate the prevalence and distribution of open-angle glaucoma (OAG) in the United States by age, race/ethnicity, and gender


Black, white and Hispanic persons with OAG

Eight studies (n = 37,229), Barbados Eye Study; Beaver Dam Eye Study; Blue Mountains Eye Study; Kongwa Eye Project; Melbourne Vision Impairment Project; Proyecto Vision Evaluation Research; Rotterdam Study, Salisbury Eye Evaluation

n/a Estimates OAG for Black, white and Hispanic persons, measured in 5-year age intervals starting at 40 years old

Covariates: age and race/ethnicity

Odds ratios (ORs) calculated for relevant variables

Pooled data for European-derived studies found a strong increase in the prevalence of OAG with age (P<0.001)

Data for black subjects derived from a single study. The prevalence of OAG increased with age, and OAG consistently more prevalent than in white subjects

Age-adjusted prevalence in Black subjects almost 3 times that of white subjects

Open-angle glaucoma affects more than 2 million individuals in the United States

Owing to the rapid aging of the US population, this number will increase to more than 3 million by 2020

More research and better data needed

Fit for purpose but heterogeneity in original studies

Non-UK study

v1.1 Page 33 of 91

Gehlbach P, Li T, Hatef E. Statins for age-related macular degeneration. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006927. DOI: 10.1002/14651858.CD006927.pub2.Study Purpose & Type




Systematic review to examine the effectiveness of statins compared with other treatments, no treatment, or placebo in delaying the onset and/or progressionof age-related macular degeneration (AMD)


People diagnosed as having early stages of AMD with no signs of choroidal neovascularization (CNV)

Two randomised, placebo-controlled trial studies: study one completed (n = 30); study two ongoing (n = 85 participants enrolled; follow-up at six, 12 and 18 months = 60, 42 & 15, respectively)

Study one: simvastatin, 20 mg/day) versus placebo for 3 months

Study two: Two tablets of simvastatin, 20 mg each, daily, compared to a placebo with an identical appearance for 3 years

Study one: serum cholesterol levels; visual acuity; microscopic eye exam; fluorescein angiography; ERG, and VEP. Measures obtained at baseline, 3 months and 4.5 months

Study two: progression of high risk early AMD to late AMD, evaluated every 6 months. Secondary outcomes colour sensitivity; flicker sensitivity; bleach recovery, and kinetics of dark adaptation

Two studies

Study one: no statistically significant difference between the simvastatin and placebo arm in visual acuity. Visual acuity was similar at 45 days after the completion of treatment

Study two: no statistically significant difference between control and treatment groups in visual acuity, drusen score or visual function at 12 months follow-up

There is insufficient evidence from RCTs to suggest that taking statins may delay the onset and progression of AMD

Strong

v1.1 Page 34 of 91

Goyal R, Shankar and J, Sullivan S (2004) Referrals for cataract surgery: variations between different geographic areas within a Welsh Health Authority. Eye, 18: 773–777Study Purpose & Type




Prospective study to identify variations in cataract presentation across the same health authority and to identify any correlation between cataract presentation and social deprivation indices

Patients aged 50 years plus presenting to cataract pre-assessment clinics over a 2-month period at three hospitals in Wales (n = 112)

Inclusion criteria included senile cataract on the first eye

n/a Ophthalmic: Visual acuity, AMD, glaucoma, diabetic retinopathy, corneal opacity; Visual Function Index (VF-14)

Demographic: Age, Sex, diabetes mellitus, hypertension, heart disease, and Social deprivation statistics

Waiting time for outpatient appointment, and surgery, and frequency of optometrist visit

Demographics were similar to National Cataract Audi

The hospital with the lowest visual acuity in both listed and fellow eye, and the lowest VF-index had the longest outpatient and surgery waiting times. The population also visited their optician least frequently

Variations in cataract presentation correlate well with social deprivation indices and poor use of optometric services

Local policies are needed to redress these inequalities and raise public and professional of causes of poor sight in the elderly population

Fit for purpose

UK study

v1.1 Page 35 of 91

Gray TA, Harper RE, Orton LC, Henson DB, et al (2009). Interventions for improving adherence to ocular hypotensive therapy. Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.Study Purpose & Type




A systematic review to summarise the effects of interventions for improving adherence to ocular hypotensive therapy in people with ocular hypertension (OHT) or glaucoma

Dependent of original studies included in review

Patients with a clinical diagnosis of glaucoma or OHT who were prescribed ocular hypotensive therapy, no limits were set for age and gender

Randomised controlled trials (RCTs) and quasi RCTs that compared interventions to improve adherence to ocular hypotensive therapy for patients with OHT or glaucoma

Primary outcomes: persistence with therapy measured by repeat prescription or dispensing counts, or both

Secondary: intraocular pressure reduction; progression of optic nerve head damage; progressive visual field loss; adverse events; and quality of life measures

Eight trials met inclusion criteria

Three of five drug comparison studies suggest reducing the frequency of OHT drops improves adherence

A small study found a reminder device beneficial to adherence yet only one of two studies involving individualised care planning was found to be successful

Interventions involving simplified dosing regimes, reminder devices, education and individualised care planning, did show improvements in adherence rates

Inadequate methodological quality and heterogeneity of study design so no particular intervention can be advocated

Strong

v1.1 Page 36 of 91

Green J, Siddall H, Murdoch I (2002) Learning to live with glaucoma: a qualitative study of diagnosis and the impact of sight loss. Social Science and Medicine, 55: 257-267.Study Purpose & Type



Results Conclusions/ Quality

Qualitative study aimed to identify triggers to self-referral for glaucoma symptoms in a sample from Britain, and to explore the meaning of symptoms for people living with moderate to severe glaucoma

Patients (n = 28) sampled from two hospitals; one specialist urban eye hospital and one District General Hospital

Visual function deficits from severe or moderately severe open angle glaucoma with no other significant ocular pathology

Twenty in-depth one-to-one interviews. Two group interviews (n = 4 each group)

n/a How participants first noticed problems with their eyesight; the process of referral to hospital; the impact of symptoms and treatment regimes on their everyday lives; hopes for the future

Participants reported low levels of awareness of glaucoma prior to diagnosis

Gradual onset meant participants had learnt to cope with diminishing sight

Managing in a 'sighted world' caused problems with everyday living, work and family life. Problems shaped primarily by social factors

Health promotion is a priority to increase public awareness of the existence and symptoms of glaucoma

More attention could be given to reducing the environmental and social causes of disability

Fit for purpose

UK study

v1.1 Page 37 of 91

Gulliford MC, Dodhia H, Chamley M, McCormick K, Mohamed M, Naithani S, Sivaprasad S (2010a) Socio-economic and ethnic inequalities in diabetes retinal screening. Diabetic Medicine, 27: 282-288.Study Purpose & Type




To quantify socio-economic and ethnic inequalities in diabetes retinal screening

Data from the retinal screening programme for three South London boroughs for the 18-month period to February 2009 (n = 59,495 records from 31,484 subjects)

n/a Ophthalmic: sight threatening diabetic retinopathy (STDR)

Demographics: age group, duration and type of diabetes, self-reported ethnicity and deprivation quintile by participant postal code

Odds ratio adjusted for specific outcome measure

Non-attendance was highest in young adults aged 18-34 years and in those aged 85 years or greater

Non-attendance was significantly higher in the most deprived quintile compared with the least deprived quintile

Compared with white Europeans, STDR was higher in Africans and African Caribbeans

Socio-economic inequality in diabetes retinal screening may be smaller than reported in earlier studies

The study suggested an increased frequency of diabetic maculopathy among participants of African origins

Fit for purpose

UK study

v1.1 Page 38 of 91

Gulliford MC, Dodhia H, Sivaprasad S, Ashworth M (2010) Family Practices’ Achievement of Diabetes Quality of Care Targets and Risk of Screen-Detected Diabetic Retinopathy. PLoS ONE 5(4): e10424. doi:10.1371/journal.pone.0010424Study Purpose & Type




Determine whether family practices’ achievement of diabetes quality of care targets is associated with diabetic retinal disease in registered patients

Patients at 144 family practiceslocated in threeLondon boroughs that contributed data to NHS Quality and Outcome Framework (QOF) for the years 2004/5 to 2007/8 (n = 24,458)

n/a Ophthalmic: diabetic retinopathy (DR) and sight threatening diabetic retinopathy (STDR)

QOF targets: proportion of patients with HBA1c 7%, by quartile

Covariates: age group, gender, type of diabetes, duration of diabetes and Indices of Multiple Deprivation (IMD)

Odds ratio adjusted for relevant outcome measures

9,332 (38%) patients had DR and 2,819 (11.5%) had STDR

Relative odds of diabetic retinopathy were 0.78 (0.69-0.88; Sig.) among participants registered at practices in the highest quartile for achievement of the HbA1c target, compared to relative odds of 1.16 (1.03-1.30; Sig.) for practices consistently in the lowest quartile

In the highest achieving practices, the relative odds of STDR were 0.77 (0.65 to 0.92; Sig.)

The risk of diabetic retinopathy might be lower at family practices that consistently achieve highly on diabetes quality of care targets for HbA1c

Strong

UK study

v1.1 Page 39 of 91

Hawthorne K, Robles Y, Cannings-John R, Edwards AG. (2008). Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trials. Diabet Med, 27(6): 613-23.Study Purpose & Type




Systematic review assessing the effectiveness of culturally appropriate diabetes health education on important outcome measures in type 2 diabetes


People with type 2 diabetes mellitus( any duration, with or without complications, from an ethnic minority group living in middle to high income countries

Eleven trials involving 1,603 people included in the review

Dependent upon studies

Primary outcomes: biomedical measures (blood pressure), patient centred measures (quality of life scales)

Secondary outcomes: (BMI, lipid levels, acute hospital admissions), patient centred measures (attitude scales, patient satisfaction scores, patient empowerment and self efficacy)

Glycaemic control (HbA1c), improved after culturally appropriate health education but effect not significant 12 months later

Knowledge scores improved in the intervention groups at all stages after intervention

Other outcomes no significant difference between groups

A need for long-term, standardised multi-centre RCTs to compare different types of culturally appropriate health education within defined ethnic minority groups

No evidence of clinical outcome improvement over time despite improvement in intermediate issues

Strong

v1.1 Page 40 of 91

Janghorbani M, Jones R, Allison S (2000) Incidence of and risk factors for cataract among diabetes clinic attendees. Ophthalmic Epidemiology, 77(1): 13 – 25.Study Purpose & Type




Study to estimate the incidence of and risk factors for proliferative diabetic retinopathy (PDR) among insulin- and non-insulin-dependent diabetics

Patients with insulin- and non-insulin-dependent diabetes attending three outpatient clinics at a hospital in Nottingham, England (n = 3482)

n/a Ophthalmic: diagnosis of PDR and non-proliferative diabetic retinopathy (NPDR).

Covariates: Gender; age; smoking history; glycosylated haemoglobin (HbA1); systolic blood pressure; duration of diabetes; creatinine and proteinuria

Incidence of PDR nearly three times higher in patients with (NPDR) as in those without any retinopathy (42.1 vs. 15.0 per 1000 person-years)

Duration of diabetes only independent predictor of PDR for patients without PDR or any retinopathy

Gender, age, BMI, creatinine, proteinuria and smoking, had no significant association with PDR

The risk of blindness was greater among those with PDR than those with NPDR in all three types of diabetes, but was substantial even for those without retinopathy

Fit for purpose

v1.1 Page 41 of 91

Jones HL, Walker EA, Schechter CB, Blanco E (2010) Vision is precious: a successful behavioural intervention to increase the rate of screening for diabetic retinopathy for inner-city adults. Diabetes Educator, 36(1): 118-126. Study Purpose & Type




Part of a randomized controlled study (Vision is Precious stuffy ) to examine the impact of a telephone intervention to increase the rate of diabetic retinopathy screening among implementation with English and Spanish speakers

Adults with diabetes living in New York (n = 305; telephone interview group)

Participants were part of the Vision is Precious study

Telephone intervention from trained health educators who were ethnically diverse and representative of the community

Documented receipt of a dilated fundus examination (DFE) within the 6-month study window

Nearly all participants who obtained a DFE did so after 4 or fewer calls. All did by the fifth call.

Participants in the intervention group who did not receive a DFE had significantly more steps in the behavioural process

A negative association between the time spent building rapport and receipt of DFE

As time spent in educational activities increased, so did likelihood of receiving a DFE

The telephone intervention was highly successful compared with the print intervention

The study demonstrates the difficulties and challenges of conducting a tailored telephone intervention to improve rates of screening in an underserved, diverse urban community

Strong

Non-UK

v1.1 Page 42 of 91

Khunti K, Kumar S, Brodie J (2009) Diabetes UK and South Asian Health Foundation recommendations on diabetes research priorities for British South Asians. Diabetes UK, 2009.Study Purpose & Type




Review report to highlight the gaps in the understanding of diabetes in the UK-based South Asian population as well as to identify recommendations and priorities for future research areas


South Asian population

n/a Various, including epidemiology, genetics, cultural aspects, screening and prevention, self-management and education, treatment and care, diabetic nephropathy, and diabetic retinopathy

Type 2 diabetes is up to six times more common in people of South Asian descent.

Prevalence of retinopathy is greater among South Asians compared to white Europeans.

Differential risk of retinopathy between South Asians and white Europeans is largely observed in those with diabetes duration of less than 10 years

Various

Priority areas for future research identified

Fit for purpose

v1.1 Page 43 of 91

Kirkwood BJ, Pesudovs K, Latimer P, and Coster DJ. (2006) The efficacy of a nurse-led preoperative cataract assessment and postoperative care clinic. Medical Journal of Australia, 184: 278–281.Study Purpose & Type




Prospective study to describe the implementation of a nurse-led preoperative cataract assessment and postoperative care clinic and to assess the safety, efficacy and outcomes

Patients referred to the Department of Ophthalmology at an Australian hospital for cataract surgery between February 2003 and August 2004 (n = 185; 221 eyes)

Nurse-led preoperative assessment clinic and nurse managed postoperative care

Concordance between nurse practitioner and ophthalmologist assessments; waiting times for first clinic appointment and surgery; visual acuity and degree of visual disability; patient satisfaction

Median waiting times fell from 115 days to 21 days for initial clinic appointment, and from 44 days to 29 days for surgery

All patients had improved visual ability and high levels of satisfaction. Quality assurance evaluations demonstrated full concordance between nurse and ophthalmologist assessments

A nurse-led cataract assessment clinic can improve access to care for public patients with cataracts.

The safety and efficacy of the program and its excellent visual and patient-centred outcomes commend its adaptation and implementation to other ophthalmology departments

Fit for purpose

v1.1 Page 44 of 91

Klein, BE (2007) Overview of Epidemiologic Studies of Diabetic Retinopathy. Ophthalmic Epidemiol, 14: 179 - 183.Study Purpose & Type




A review of recent advances in diagnosis, treatment, temporal trends, and health care for diabetic retinopathy (DR)


n/a Dependent upon original study included in the review

Mainly prevalence of diabetic retinopathy


Studies of the variability of diabetic retinopathy have demonstrated the high prevalences and incidences of this condition

Observational studies and clinical trials have documented the importance of glycemic and blood pressure control in the development and progression of diabetic retinopathy

Fit for purpose

v1.1 Page 45 of 91

Klein R, Klein BE, Knudtson MD, Wong TY, Cotch MF, Liu K, Burke G, Saad MF, Jacobs DR Jr. (2006) Prevalence of age-related macular degeneration in 4 racial/ethnic groups in the multi-ethnic study of atherosclerosis. Ophthalmology, 113(3): 373-80.Study Purpose & Type




Prospective cohort study to examine the prevalence of age-related macular degeneration (AMD) in 4 racial/ethnic groups

Participants aged 45 to 85 years old from 4 racial/ethnic groups (white, black, Hispanic, and Chinese) that participated in the second examination of the Multi-ethnic Study of Atherosclerosis (MESA; n = 6176)

Participants drawn from 6 United States Communities

n/a Ophthalmic: presence of AMD

Covariates: age, pupil size, presence of hypertension, presence of diabetes, alcohol intake, current smoking status, and body mass index

Prevalence of AMD were 2.4% (black), 4.2% (Hispanic), 4.6% (Chinese), to 5.4% (white); significant difference between all groups

The highest prevalence of any AMD occurred in those 75 to 84 years old

Age, gender, pupil size, body mass index, smoking, alcohol intake, diabetes, and hypertension status did not explain the variability in the 4 groups

Low prevalences of AMD were found in the MESA cohort in all groups

A lower prevalence of AMD was found in blacks compared with whites. The higher prevalence of exudative AMD in Chinese needs further study

Strong

Non-UK study

v1.1 Page 46 of 91

Lacey J, Cate H, Broadway DC. (2009). Barriers to adherence with glaucoma medications: a qualitative research study. Eye. Vol. 23, pt. 4.Study Purpose & Type




Better understanding of obstacles to, and the motivations for, adherence with glaucoma medication and potential methods to improve adherence

24 participants with moderate to severe glaucoma who attended NHS ophthalmic departments at Norfolk and Norwich University Hospital and Cromer and District Hospital

7 participants were included in two focus groups (one at each hospital, total participants = 14) and 10 participants completed a questionnaire

Qualitative measures (focus groups, questionnaires) to investigate various aspects of adherence to glaucoma medications

Framework analysis and NVIVO software to check data reliability

Multiple obstacles to adherence were identified, including poor education, lack of motivation, forgetfulness, drop application, and other practical issues, together with specific individual and age differences. Motivation for adherence was determined by fear of blindness and a faith in drop efficacy

Specific obstacles to adherence with anti-glaucomatous therapy should be identified early after diagnosis. Tailored education about consequences may improve patients motivations for adherence

More research needed on how to deliver education about glaucoma management

Fit for purpose: no intervention, reasonable inferences

UK Study

v1.1 Page 47 of 91

Leese GP, Ahmed S, Newton RW, Jung RT, Ellingford A, Baines P, Roxburgh S, Coleiro J (1993) Use of mobile screening unit for diabetic retinopathy in rural and urban areas British Medical Journal, 306: 187–189.Study Purpose & Type




Prospective study to examine the effectiveness of a mobile screening unit in detecting diabetic retinopathy (DR) in rural and urban areas

Patients in the Tayside region of Scotland presenting for diabetic retinopathy screening over a two year period (n = 2186)

n/a Ophthalmic: presence of diabetic Retinopathy; and need for laser photocoagulation

Covariates: age; duration of diabetes; and diabetic treatment

Patients in rural areas less likely to attend a hospital based diabetic clinic (p <0.001)

Correcting for age, patients in rural areas more likely to have advanced DR (p < 0001) and require laser photocoagulation for previously unrecognised retinopathy (p < 0.02)

Screening cost £10 per patient and £1000 per patient requiring treatment

Mobile diabetic eye screening detected a greater prevalence of advanced retinopathy in diabetic patients living in rural areas

Patients in rural areas were more likely to need urgent laser photocoagulation

Rural patients may benefit more from mobile screening units than urban patients

Fit for purpose

v1.1 Page 48 of 91

Leese GP, Boyle P, Feng Z, Emslie-Smith A, Ellis JD. (2008). Screening uptake in a well-established diabetic retinopathy screening program: the role of geographical access and deprivation. Diabetes Care. Vol. 31, pt. 11.Study Purpose & Type




To identify criteria that affect uptake of diabetes retinal screening in a community screening program using mobile retinal digital photography units

16, 258 (average age 63+ years) patients with diabetes in 69 general practices in Tayside, Scotland. Eye screening data from 15, 150 patients was included in the study

Patients assigned anonymously to census based geographical areas based on residential postcodes and comparisons made regarding uptake of screening services (static and mobile)

Geographical information systems were used to measure geographical data and ‘Carstairs’ deprivation scale to measure deprivation

Random effects logit models were used to model the propensity of missing eye screenings

Highest proportion of non-attendees came from urban and deprived areas (with the exception of Dundee) even though these patients had the shortest distance to travel

Younger people and patients with a long history of diabetes were also likely to miss the screening

Static screening centres are more effective than mobile centres

Social deprivation is strongly associated with non attendance but geographical distance seems to have no effect

Further improvement is needed to reach those in socially deprived areas

Strong

v1.1 Page 49 of 91

McLaughlan B, Edwards A (2010) Understanding of the Purpose of an Eye Test Among People Aged 60 and Over in the UK. Optometry in Practice; 11:4 179–188.Study Purpose & Type




Cross sectional study to examine the barriers to eye examinations among older people

Members of the 50plusview panel aged 60+ (n = 3848)

Self reported questionnaire administered across the UK

n/a General perceptions about the frequency and purpose of eye tests

Personal experience andattitudes towards eye tests

Nearly half of respondent attend for an eye exam every year

Top three reasons given for an eye exam: check prescriptions; check health of the eyes; and early detection of eye disease. ‘Most important reason’, detection of eye disease

Top three reasons for non attendance: not had an eyesight problem; expense of glasses; not considered it necessary

People fear being blind to a greater extent than other disabilities

The overwhelming majority of respondents cited checking prescriptions as a reason forhaving an eye test

The most frequently given reason for not having had an eye test is not having had anyeyesight problems

Fit for purpose

v1.1 Page 50 of 91

McLaughlan B, Winyard S (2007) Don’t blame the patient! A call for action to eliminate unnecessary sight loss from glaucoma. RNIB campaign report 27. Study Purpose & Type




RNIB Campaign Report – consensus report from series of expert meetings and literature review to summarise evidence on compliance in Glaucoma treatment

n/a n/a Based on registrations and summarises findings from other studies

Highlights key risk factors and importance of adherence to treatment plans as well as early detection

Need of a concerted strategy including better pathways and attitude to compliance in design

Weak but fit for purpose

v1.1 Page 51 of 91

McNeil, JJ Robman, L Tikellis, G Sinclair, MI McCarty, CA Taylor, HR (2004). Vitamin E supplementation and cataract: randomized controlled trial. Ophthalmology. Vol. 111, pt. 1.Study Purpose & Type




A prospective, randomized, double-masked, placebo-controlled clinical trial to determine whether treatment with vitamin E (500 IU daily) reduces either the incidence or rate of progression of age-related cataracts

1, 193 volunteers with early or no cataract aged 55- 80 years in a screening program in Melbourne, Australia were randomly assigned to the intervention or control group

Participants were assigned randomly to receive either 500 IU of natural vitamin E in soybean oil encapsulated in gelatin or a placebo with an identical appearance

The incidence and progression rates of age-related cataract were assessed annually for four years with both clinical lens opacity gradings and computerized analysis of Scheimpflug and retroillumination digital lens images obtained with a Nidek EAS-1000 lens camera

87% (74% = intervention, 76% = control) of participants competed the four years cycle.

Vitamin E did not reduce the incidence or progression of any type of cataract

Vitamin E has no effect on the incidence and progression of all types of cataract

Strong

v1.1 Page 52 of 91

Mikelberg FS, Schulzer M, Drance SM, Lau W (1986) The rate of progression of scotomas in glaucoma. Am J Ophthalmol., 101(1): 1-6.Study Purpose & Type




Retrospective study to evaluate the rate of progression of scotomas

Patients with glaucoma for whom demographic data were stored on computerised records in an ophthalmology clinic in Canada (n = 45)

Only patients with routine open angle chronic glaucoma included. Patients with low tension glaucoma were excluded

n/a Ophthalmic: scotoma mass, calculated and regressed on time to obtain the rate of visual field change

Twenty-two eyes (49%) showed a linear type of progression, nine (20%) showed a curvilinear progression, three (7%) showed episodic progression, and 11 (24%) showed no significant progression

Nerves may be lost in the optic nerve with minimal changes to visual field

After a certain point, loss of visual field is more linear and rapid as little functional nerve remains intact

A progressive study is required on progression of field loss in glaucoma as well as the factors that may influence progression of the disease

Fit for purpose

v1.1 Page 53 of 91

Muir KW, Santiago-Turla C, Stinnett SS et al. (2009). Glaucoma patients' trust in the physician. Journal of Ophthalmology.Study Purpose & Type



Results Conclusiosn Quality

A cross-sectional patient survey to describe glaucoma patients' trust in the physician and to test the hypothesis that increased interpersonal trust is associated with increased medication adherence

195 participants with open-angle glaucoma seen by multiple glaucoma subspecialists at Glaucoma Service of Duke University Eye Center, NC

Each participant was seen by one of four glaucoma subspecialists

n/a Survey including demographic data, the Mini-mental State Exam (MMSE), a word recognition test and the trust in physician scale (TPS)

Descriptive statistics for initial results, relationship between demographic data and TPS was assessed using analysis of variance or linear regression

Patients from ethnic minorities had slightly less trust in their physician than white patients

Trust in physician was not associated with glaucoma medication adherence in this sample population

A better understanding of the patient – physician relationship between “races” is needed

Strong

Non-UK study

v1.1 Page 54 of 91

Nazroo J Y (2005) The social determination of ethnic/racial inequalities in health. In Social Determinants of Health (Second Edition), ed. M. Marmot and R.G. Wilkinson, 238-266.Oxford: Oxford University Press, 2005.Study Purpose & Type




Review of previous studies examining the social determination of ethnic/racial inequalities in health


n/a Ethnic./racial disadvantage

Ethnic patterning of health

Socio-economic patterning of health

Age

Impact of racial harassment and discrimination

Social support networks and participation

Various There remain ongoing problems with the data to available to explore ethnic inequalities in health

A large body of evidence now supports the possibility that ethnic inequalities in health are largely the consequence of socio-economic differentials but does not explain the relationship between ethnicity and socio-economic inequality

Fit for purpose

v1.1 Page 55 of 91

Ng, WS, Agarwal PK, Sidiki S, McKay L, Townend J, Azuara-Blanco A (2010) The effect of socio-economic deprivation on severity of glaucoma at presentation. Br J Ophthalmol, 94: 85-87.Study Purpose & Type




Cross sectional study to evaluate the influence of socio-economic factors on severity of glaucoma at presentation

All newly diagnosed glaucoma patients at two hospitals in Scotland, in 2006 (n = 126; 48 severe glaucoma; 74 non-severe glaucoma; 4 not determined)

n/a Ophthalmic: severity of glaucoma at presentation

Demographics: age and gender

Socio-economic: Scottish Index of Multiple Deprivation

Severity of glaucoma at presentation was significantly associated with SIMD rank, being most severe in patients from areas with the lowest ranks

Age was a significant factor with severe glaucoma being more common in elderly patients

Age and socio-economic deprivation were associated with severity of glaucoma at presentation, with patients from areas of higher socio-economic deprivation presenting with more advanced glaucoma

Fit for purpose

v1.1 Page 56 of 91

Nordmann J-P, Baudouin C, Renard J-P, Denis P, Lafuma A, Laurendeau C, Jeanbat V, Berdeaux G (2010a) Measurement of treatment compliance using a medical device for glaucoma patients associated with intraocular pressure control: A survey. Clinical Ophthalmology, 4: 731–739.Study Purpose & Type


Intervention Outcome Measures Results Conclusions Quality

Observational survey to identify and characterize treatment compliance profiles of glaucoma patientsand evaluate the association with intraocular pressure (IOP)

Patients attending specialised glaucoma treatment in 17 centres in France (n = 140)

n/a Compliance rates for weekdays and weekends, over 8 consecutive weeks

Demographics: inclusion and exclusion findings, socio-demography, POAG/OHT history, current treatment, IOP and visual acuity

Principal components analysis (PCA) and ascendant hierarchical classification (AHC) to identify compliance groups

IOP was 23.9 mmHg at baseline and 16.1 mmHg at 8 weeks; 17.7 mmHg in low compliance group AHC identified 3 compliance groups: ‘high’ (56.6%, approx. 80% compliance), ‘medium’ (21.2%, approx. 50% compliance), and ‘low’ (22.1%, approx. 20% compliance)

Demographics and glaucoma parameters did not predict low compliance

Compliance measurement by a medical device showed compliance rates <80% by 50% (approx.) of patients, significantly impacting IOP control

No demographic or glaucoma variable was associated with low compliance

Fit for purpose

v1.1 Page 57 of 91

Nordmann JP, Baudouin C, Renard JP et al (2010b) Identification of noncompliant glaucoma patients using Bayesian networks and the Eye-Drop Satisfaction Questionnaire. Clinical Ophthalmology, 4: 1489-1496.Study Purpose & Type




Observational cross-sectional study To identify poorly compliant glaucoma patients, using the Eye-Drop SatisfactionQuestionnaire (EDSQ)

Patients with primary open-angle glaucoma (POAG) or ocular hypertension attending specialised treatment at 17 sites in France (n = 169)

Inclusion: used Travalert device eight weeks; 18 years of age; and either POAG or high IOP

Secondary glaucoma excluded

n/a Eye-Drop Satisfaction Questionnaire

Compliance profile derived from Travalert® data

A Bayesian network (BN) was applied to explore compliance associations with EDSQ

Low compliance associated with age <77.5 years plus poor patient–physician relationship

Patients aged >77.5 years with a poor patient–physician relationship and declared good compliance

High compliance associated with patients < 77.5 years old with good patient-physician relationship

The patient–physician relationship plays a central role in the compliance process

Age, self-declared compliance, and patient satisfaction with the patient–physician relationship are all dimensions worth exploring before glaucoma medication is switched or proceeding to laser treatment or surgery

Fit for purpose

v1.1 Page 58 of 91

Nordstrom BL, Friedman DS, Mozaffari E, Quigley HA, Walker AM (2005) Persistence and adherence with topical glaucoma therapy. Am J Ophthalmology. 140(4): 598-606.Study Purpose & Type




A retrospective cohort study to examine the patterns and predictors of treatment persistence and adherence among patients who are diagnosed with glaucoma or as glaucoma suspects

Newly treated individuals with diagnosed glaucoma (n = 3623) and suspect glaucoma (n = 1677).

Patient records obtained from healthcare claims data in the Ingenix Research Database

Four drug classes were included in the study: beta-blockers, alpha-agonists, carbonic anhydrase inhibitors, and prostaglandin analogs

Duration of continuous treatment with the prescribed medication (persistence)

Prevalence of use of the initial medication at various time points (adherence)

Relative risk (RR) for outcome measures: patients diagnosed with glaucoma vs. glaucoma suspects

Nearly one half of individuals had discontinued all topical ocular hypotensive therapy within six months

37% of these individuals had refilled their initial medication at three years after first dispensing

Patients with diagnosed glaucoma more likely to adhere to therapy than with suspect glaucoma (RR = 1.11; 95% CI, 1.05-1.18)

Patients with diagnosed open-angle glaucoma were more likely to adhere to treatment than suspected glaucoma

Persistence and adherence were substantially better with prostaglandins than with other drug classes

Fit for purpose

v1.1 Page 59 of 91

Norregaard JC, Bernth-Petersen P, Alonso J, Dunn E, Black C, Andersen TF, Bernth-Petersen P, Bellan L, Espallargues M (1997) International variation in ophthalmologic management of patients with cataracts. Results from the International Cataract Surgery Outcomes Study. Arch Ophthalmol, 115(3): 399–403.Study Purpose & Type




Cross-sectional study to describe international variation in the management of patients with cataracts in 4 health care systems and to discuss the potential implications for cost and utilisation of services

Ophthalmologists in the United States (n = 526), Canada (n = 276), Spain (n = 89), and Denmark (n = 82)

n/a Most surgeons reported that they performed A-scanning, fundus examination, and refraction routinely before surgery

Significant cross-national variation was observed in preoperative ophthalmic and medical testing

Both within and across sites, considerable variation in number of follow-up visits and postoperative tests was observed

A significantly higher proportion of surgeons in the United States and Spain reported less than 100 extractions per year compared with surgeons in Canada and Denmark (P < .001)

Significant international variation in the management of healthy patients with cataracts has been observed

If less intensive care is not associated with poorer outcomes, there is the potential for less costly care of patients with cataracts

Fit for propose

v1.1 Page 60 of 91

O’Donnell K. (2009) Eye care in the UK: Epidemiology, intervention and Ethnicity. PHAST reportStudy Purpose & Type




Literature review produced for NHS Tower Hamlets in September 2009 as part of the ‘Care Needs Assessment: Eye Health’ project commissioned by NHS Tower Hamlets


n/a Epidemiology and clinical appearance of the four main causes of visual impairment in the UK: glaucoma, cataract, diabetic retinopathy and age-related macular degeneration

Interventions and treatments, together with available data on cost analysis or effectiveness.

The needs of special groups

Various

Dependent on the cause of visual impairment and group included in the review

A number of key points emerge from the literature which may be useful when formulating interventions: 1) the importance of family; 2) age is a major risk factor; 3) ethnicity is a determinant of risk: 4) the need for targeted screening and holistic assessment; and 5) investment should be made in low vision services

Fit for purpose

v1.1 Page 61 of 91

O'Hare JP, Raymond NT, Mughal S, Dodd L, Hanif W, Ahmad Y, Mishra K, Jones A, Kumar S, Szczepura A, Hillhouse EW, Barnett AH (2004) Evaluation of delivery of enhanced diabetes care to patients of South Asian ethnicity: the United Kingdom Asian Diabetes Study (UKADS). Diabet Med., 21(12): 1357-65.Study Purpose & Type




Cluster randomized controlled trial to test the hypothesis that enhanced care for diabetes, tailored to the needs of the South Asian community with Type 2 diabetes, would improve risk factors for diabetic vascular complications and ultimately reduce morbidity and mortality

Patients at six General Practices in the UK West Midlands, with a high population of South Asians (n = 361; n = 325 ad 12-month follow-up)

Eligible patients were of South Asian ethnicity with Type 2 diabetes and either elevated blood pressure, elevated glycated haemoglobin (HbA1c) or raised total cholesterol

Intervention: 'enhanced care' using Asian link workers, an additional practice nurse session per week and community diabetes specialist nurse input

Control: continued standard practice care

Blood pressure, HbA1c and lipid control after one-year follow-up

At one-year follow-up a significant difference in reduction of systolic and diastolic blood pressure, and total cholesterol, in the intervention groups

Adjusting for baseline and age, only differential reduction in diastolic blood pressure was significant

There was no significant change in HbA1c and no difference between groups

Small reductions in blood pressure and cholesterol were achieved, but improvement in glycaemic control may require longer different strategies

Using link workers and extra community diabetes specialist nurse input might prove a useful strategy in working towards NSF targets

Further research is required to evaluate effectiveness

Strong

UK study

v1.1 Page 62 of 91

Okeke CO, Quigley, Jampel HD, Ying G, Plyer RJ, Jiang Y, Friedman DS (2009). Interventions Improve Poor Adherence with Once Daily Glaucoma Medications in Electronically Monitored Patients. Ophthalmology. Vol. 116, pp. 2286-2293.Study Purpose & Type




A randomised controlled trial to investigate the impact of an intervention program to improve adherence with topical, once daily therapy for glaucoma

66 patients aged 18+ years with open angle glaucoma, angle-closure glaucoma, glaucoma suspect, or ocular hypertension attending the Glaucoma Services of the Wilmer Eye Institute and the Scheie Eye Institute in Philadelphia, PA USA

Intervention group: educational video, structured discussion, reminder telephone calls

Control group: standard care

Change in drop usage adherence as determined by the DA device

Statistical analysis of results

Patients in the intervention group mean of scheduled doses increased in the three months after intervention. The control mean adherence rate at baseline was statistically unchanged during the follow up

A multifaceted intervention significantly increased adherence with glaucoma medications, further research is needed to determine which components of this intervention were most effective

Fit for purpose

v1.1 Page 63 of 91

Pappa C, Hyphantis T, Pappa S, Aspiotis M, Stefaniotou M, Kitsos G, Psilas K, Mavreas V. (2006) Psychiatric manifestations and personality traits associated with compliance with glaucoma treatment. J Psychosom Res, 61(5): 609-17.Study Purpose & Type




Cross-sectional study to assess the impact of psychological distress and personality traits on self-rated compliance with glaucoma treatment

Patients with primary open angel glaucoma ((POAG (n = 100)

Eligible for entry were patients with either previously diagnosed POAG or exfoliation glaucoma and who had already received ocular hypotensive agents

Other types of glaucoma and other ophthalmic conditions were excluded

n/a Compliance with treatment: via qualitative interviews

Psychometric outcomes: General Health Questionnaire; Symptom Distress Checklist;Centre for Epidemiological Studies Depression Scale;Defence Style Questionnaire; Hostility and Direction ofHostility Questionnaire

Forty-two percent of patients were non-compliers (omitted more than two doses per week). Non-compliers presented more severe symptoms of glaucoma. Depression associated with poor compliance. Adoption of immature defensive style further increased the risk for non-compliance

Depression is associated with self-reported non-compliance with glaucoma treatment, whereas certain personality traits are involved in the increased risk for non-compliance

Fit for purpose

Non-UK study

v1.1 Page 64 of 91

Pardhan S, Gilchrist J, Mahomed I (2004) Impact of age and duration on sight-threatening retinopathy in South Asians and Caucasians attending a diabetic clinic. Eye, 18(3): 233-40.Study Purpose & Type




Prospective study to examine diabetic retinopathy in Asians and Caucasians attending a hospital diabetic clinic

Diabetic patients who attended an outpatient diabetic clinic in Bradford between March 1996 and December 1997 (n = 500; 268 Asians, 232 Caucasians)

Patients were included if they were over 40 years of age, were diagnosed as diabetic, and had not been treated for any other eye diseases such as glaucoma

n/a Ophthalmic: existence of sight-threatening Retinopathy (STR)

Covariates: age of the patient; duration of diabetes; gender; insulin-requiring status; and HbA1 levels

Significant association of STR with race, age and duration of diabetes, with no significant interaction effect between variables

Logistic regression predicted Caucasians are approximately 12.5 years older and/or have had diabetes for 12.5 years more to have the same STR levels compared to Asians

After adjusting for age and duration of diabetes, the probability of STR in Asian diabetic patients in Bradford is significantly higher than that in (white) Caucasians

The impact of age and duration was significantly higher in patients of South Asian origin compared to (white) Caucasians

Fit for purpose

UK study

v1.1 Page 65 of 91

Patel D, Baker H & Murdoch I. (2006). Barriers to uptake of eye care services by the Indian population living in Ealing, west London. Health Education Journal. Vol. 65, pt. 3. Study Purpose & Type




This study in Ealing, London was aimed at determining the reasons for poor utilization of eye care services by the Indian population

44 participants male and female from three different stakeholder perspectives of community, patients and health in Ealing took part in the study in community centres, temples and GP practices around the borough

n/a Various data collection methods

Analysis used a thematic framework involving five distinct steps:(1) Familiarization(2) Identifying a thematic framework(3) Indexing(4) Charting(5) Mapping and interpretation

The study found two distinct types of barriers that affected the Indian population of Ealing those that are due to misconceptions about eye diseases and those that come from experience of health and social care services

Relationships between GPs and their Indian patients in Ealing need to be examined further

Strategies for overcoming identified barriers need to be created

Fit for purpose

v1.1 Page 66 of 91

Quigley H, & Broman, S (2006) The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmology, 90(3): 262-7.Study Purpose & Type




A review of published data to estimate the number of people with open angle (OAG) and angle closure glaucoma (ACG) in 2010 and 2020 using prevalence models constructed by age, sex, and ethnicity


Data from population based studies of age specific prevalence of OAG and ACG that satisfied standard definitions

Models were combined with UN world population projections for 2010 and 2020 to derive the estimated number with glaucoma

n/a Prevalence models for OAG and ACG by age, sex, and ethnicity, weighting data proportional to sample size of each study

60.5 million people with OAG and ACG in 2010

79.6 million people with OAG and ACG by 2020. Of these, 74% will have OAG

Glaucoma is the second leading cause of blindness worldwide, disproportionately affecting women and Asians

Fit for purpose

v1.1 Page 67 of 91

Racette L, Wilson MR, Zangwill LM, Weinreb RN, Sample PA. (2003). Primary open-angle glaucoma in blacks: a review. Surv Ophthalmol. May-Jun; 48(3): 295-313.Study Purpose & Type




Review of published literature to inform ongoing ADAGES African Descent and Glaucoma Evaluation Study (USA)

n/a n/a Various depending on publications

POAG prevalence is estimated six times as high in Black Americans in certain age groups compared to whites. POAG more likely to result in irreversible blindness, appears approximately 10 years earlier and progresses more rapidly in blacks than in whites. Blacks have larger optic disks than whites. Racial differences in intraocular pressure remain unclear

There is evidence that blacks are less responsive to both drug and surgical treatment for POAG. They often have reduced accessibility to treatment and are less aware of the risks of having POAG

Fit for purpose

Non-UK study

v1.1 Page 68 of 91

Reidy A, Minassian DC, Vafidis G, Joseph J, Farrow S, Wu J, Desai P, Connolly A (1998). Prevalence of serious eye disease and visual impairment in a north London population: population based, cross sectional study. BMJ. 30; 316(7145): 1643–1646.Study Purpose & Type




Cross sectional survey to estimate the magnitude of serious eye disorders and of visual impairment in a defined elderly population of a typical metropolitan area in England

Random sample of people aged 65 and older, drawn from a defined population of elderly people registered with 17 general practice groups (n = 1547)

n/a Proportions and population prevalence estimates for visual acuity

Classified into four categories: prevalence of cataract, age related macular degeneration, and refractive error causing visual impairment and of definite primary open angle glaucoma

Status of contact with eye services

The population prevalence of bilateral visual impairment was 30%; 72% was potentially remediable

88% of people with cataracts not in touch with the eye services

Prevalence of AMD was 8% and of glaucoma 3%

Three quarters of people with definite glaucoma were not known to the eye services

Untreated visual impairment and eye disorders affect a substantial proportion of people aged 65 years and older

Strong

v1.1 Page 69 of 91

Rose K, Waterman H, Toon L, Mcleod D, Tullo A (1999) Management of day surgery patients with cataract attending a peripheral ophthalmic clinic. Eye, 13: 71-75Study Purpose & Type




To compare two organisationalmodels of management for patients withcataract referred to a peripheral ophthalmicclinic who underwent day-surgery at a maineye hospital

Patients with cataract attending a peripheral ophthalmic clinic

Patients were randomly drawn to receive either an experimental (group A; n = 25) or control (group B; n = 24) model of care

Experimental group received pre-operative assessment by a trained ophthalmic nurse at the peripheral clinic immediately following diagnosis of cataract and diary-booking for surgery

The control group received a separate appointment for pre-operative assessment at the main hospital

Ophthalmic: visual acuity, subjective visual function (VF-14)

Anxiety and depression

Patient satisfaction

Cost-benefit analysis

No significant differences between the experimental and control groups with respect to visual acuity, subjective visual function or anxiety and depression

The experimental model was a more cost-effective means of care delivery

Overall, patients preferred the experimental model

Nurse-led pre-operative assessment of patients with cataract at a peripheral ophthalmic clinic is safe, cost-effective and is preferred by patients

Strong

v1.1 Page 70 of 91

Rudnicka AR, Mt-Isa S, Owen CG, Cook DG, Ashby D (2006) Variations in Primary Open-Angle Glaucoma Prevalence by Age, Gender, and Race: A Bayesian Meta-Analysis. Investigative Ophthalmology & Visual Science. 47:4254–4261.Study Purpose & Type


Intervention Outcome Measures Results Conclusions Quality

A systematic review to quantify the variation in primary open-angle glaucoma (OAG) prevalence with age, gender, race, year of publication, and survey methodology


Forty-six published observational studies of OAG prevalence were included (n = 103,567 participants; 2509 cases of OAG)

Population-based surveys were included that examined an entire town/ village/ geographic region or used clearly defined random or clustered sampling

n/a Number of people and cases of OAG by age, race, and gender

Information on whether the definition of glaucoma relied on raised intraocular pressure (IOP) and whether visual field examination

Bayesian model associations between log odds of OAG and age, race, gender, year of publication, method of visual field testing, and reliance on IOP

Black populations had the highest OAG prevalence at all ages, but proportional increase with age was highest in white populations

Prevalence in those older than 70 was 6% in whites, 16% in blacks, and 3% in Asians

Prevalence of OAG was one third lower in studies in which visual fields were not assessed and IOP was used in the definition of glaucoma

Although black populations had the highest prevalence of OAG at all ages, white populations showed the steepest increase in OAG prevalence with age

Men were more likely than women to have OAG

StrongVery sophisticated statistical approachNB ‘Asian’ may not compare to UK usage of term. Only ‘Asian’ study based on Japanese cases, and classifies Chinese, Eskimo (Inuit) and Thai as ‘Asian’

v1.1 Page 71 of 91

Salisbury C, Wallace M, Montgomery AA (2010) Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling. BMJ, 341:c5004 Study Purpose & Type




Secondary analysis of data from a study of access to general practice, to explore whether responses to questions of patients that purport to assess the performance of general practices or doctors, reflect differences between practices, doctors, or the patients themselves

Secondary analysis of data obtained from a survey of patients’ satisfaction done in 47 practices in 9 primary care trusts in England, in 2005-6 (n = 4573 patients who consulted 150 different doctors in 27 practices)

n/a Overall satisfaction; experience of wait for an appointment; reported access to care; satisfaction with communication skills

Wait for an appointment more discriminating than overall satisfaction

79% of the variance occurred at the patient level Patients' age, sex, ethnicity, and housing and employment status explained some variation

Adjustment for patients’ characteristics made very little difference to practices or the individual ranking

Measures related to patients’ experience discriminate more effectively than do measures of general satisfaction

Surveys of patients satisfaction fail to distinguish between individual doctors because most variation in doctors’ performance is due to differences between patients and random error rather than differences between doctors

Fit for purpose

v1.1 Page 72 of 91

Saxena S, Misra T, Carr J, Netuveli G, et al. (2007). Systematic review of primary healthcare interventions to improve diabetes outcomes in minority ethnic groups. Journal of Ambulatory Care Management. Vol. 30, pt. 3, pp. 218-30.Study Purpose & Type




To systematically review the effectiveness of primary care interventions on glycaemic control and cardiovascular risk factors in minority ethnic groups with diabetes


2, 565 participants form 9 separate studies based in primary care practices

Dependent upon study

Statistical analysis Two main models of care were identified: (1) case management, with specialist diabetes nurses and community health workers and (2) the use of the services of link workers from minority ethnic groups to guide people with diabetes

Case management in minority ethnic groups with diabetes, improves glycaemic control and cardiovascular risk factors

Link workers improve control of cardiovascular risk factors

Relative effectiveness, cost, and sustainability over time warrant further evaluation

Strong

v1.1 Page 73 of 91

Scanlon PH, Carter SC, Foy C, Husband RFA, Abbas J and Bachmann MO (2008) Diabetic retinopathy and socioeconomic deprivation in Gloucestershire. J Med Screen 2008;15:118–121Study Purpose & Type




A cross-sectional study to investigate socioeconomic variations in diabetes prevalence, uptake of screening fordiabetic retinopathy, and prevalence of diabetic retinopathy (DR)

Individual levelrecords from the Gloucestershire Diabetic Eye Screening Service (GDESS) database

Data from 85 GP practices

Dataset 1 — all patients on the GDESS database at December 2002. Dataset 2 — patients who had been screened for diabetic retinopathy up to February 2003

n/a Diabetes prevalence with odds ratios, uptake of screening, prevalence of any retinopathy and prevalence of sight-threatening retinopathy (STDR) at screening compared for different area deprivation quintiles

Logistic regression was used to adjust for confounding

With each quintile of deprivation, diabetes prevalence increased, probability of being screened for DR decreased, and prevalence of STDR in screened patients increased

Prevalence of non-sight-threatening diabetic retinopathy was unchanged with each increasing quintile of deprivation

The National Screening Programme needs to attract socioeconomic deprived groups to attend, as these people are at the most risk of STDR

Strong

v1.1 Page 74 of 91

Scully ND, Chu L, Siriwardena D, Wormald R, Kotecha A (2009) The quality of optometrists’ referral letters for glaucoma. Ophthalmic and Physiological Optics, 29(2): 26-31.Study Purpose & Type




Prospective study to evaluate the quality of content of optometrist-initiated glaucoma referral letters arriving at the appointment booking centre of a London based eye hospital

All new glaucoma referral arriving at the appointment booking centre of a London based eye hospital over a 4-month period commencing in December 2006 (n = 121)

Referrals for patients with previously diagnosed or previously suspected glaucoma were omitted

n/a Quality of the referral letter

Acceptable: all information on General Ophthalmic Services (GOS) 18 referral form

Ideal: as above plus risk factors, visual field assessment, optometrist's diagnosis and referral speed

Fail: letters not satisfying all criteria

Forty-nine per cent of referral letters found of acceptable quality, 7% ideal and the remainder classed as fail

Main reason for failure was an omission of non-clinical information

Two-thirds of acceptable letters lacked discussion of risk factors, visual field analysis or recommendations for referral speed

There is a need to improve the quality of optometrists' glaucoma referral letters, particularly with respect to completion of all the items set out on the GOS 18 referral form

Fit for purpose

v1.1 Page 75 of 91

Seddon JM, George S, Rosner B (2006) Cigarette Smoking, Fish Consumption, Omega-3 Fatty Acid Intake, and Associations With Age-Related Macular Degeneration. The US Twin Study of Age-Related Macular Degeneration. Arch Ophthalmol. 124:995-1001Study Purpose & Type




To evaluate modifiable risk and protective factors for age-related macular degeneration (AMD) among elderly twins

Male twins from the National Academy of Sciences–National Research Council World War II Veteran Twin Registry

Cohort includes n = 681 twins: 222 twins with AMD (intermediate or late stages) and 459 twins with no maculopathy or early signs

n/a Ophthalmic: signs of AMD using slitlamp Biomicroscopy. Retinal photography

Dietary: food frequency questionnaires

Risk factors: demographic characteristics, cigarette smoking, alcohol intake, and physical activity

Odds ratio for specific outcome measure

Current smokers had a 1.9-fold increased risk of AMD

Past smokers had about a 1.7-fold increased risk Increased intake of fish reduced risk of AMD, particularly for 2 or more servings per week

Cigarette smoking increases the risk of AMD while fish consumption and omega-3 fatty acid intake reduce risk of AMD

Strong

Non-UK study

v1.1 Page 76 of 91

Smeeth L, Fletcher AE, Hanciles S, Evans J, Wormald R (2003) Screening older people for impaired vision in primary care: cluster randomised trial. BMJ, 327: 1027-1032.Study Purpose & Type




Cluster randomised trial to determine the effectiveness of screening for visual impairment in people aged 75 or over aspart of a multidimensional screening programme

People aged 75 years or over randomly sampled from 20 general practices (n = 4340)

People resident in hospitals or nursing homes were excluded

Visual acuity testing and referral to eye services for people with visual impairment

Universal screening (assessment and visual acuity testing) was compared with targeted screening, in which only participants with a range of health related problems were offered an assessment that included acuity screening

Proportion of people with visual acuity less than 6/18 in either eye

Mean composite score of 25 item version of the National Eye Institute visual function questionnaire

3-5 years after screening, the relative risk of visual acuity < 6/18 in either eye, (universal vs. targeted screening), was 1.07 (95% CI 0.84 to 1.36; NS)

Mean composite score of visual function questionnaire 85.6 in targeted screening group and 86.0 in the universal group (difference 0.4, 95% CI 1.7 to 2.5, NS)

Including a vision screening component by a practice nurse in a pragmatic trial of multidimensional screening for older people did not lead to improved visual outcomes

Strong

v1.1 Page 77 of 91

Smith W, Assink J, Klein R, Mitchell P, Klaver CC, Klein BE, Hofman A, Jensen S, Wang JJ, de Jong PT. (2001) Risk factors for age-related macular degeneration: Pooled findings from three continents. Ophthalmology, 108(4): 697-704.Study Purpose & Type




Combined analysis of population-based eye disease prevalence data to assess the prevalence and potential risk factors for late age-related macular degeneration (AMD) in three racially similar populations from North America, Europe, and Australia

Participants with gradable photographs from the Beaver Dam Eye Study (n = 4756), Rotterdam Study (n = 6411), and Blue Mountains Eye Study (n = 3585)

n/a Ophthalmic: presence of AMD (geographic atrophy (GA) and neovascular NV)

Covariates: age, gender, tobacco smoking, body mass index, presence of hypertension, cholesterol, iris colour, age at menopause, and hormone replacement therapy

AMD present in 0.2% of the combined population aged 55 to 64 years, rising to 13% of population older than 85 years

No significant gender differences in the prevalence of AMD (either NV or GA)

Age and smoking the only risk factors associated with any form of AMD in sites separately and in pooled analyses

The study provides strong and consistent evidence that tobacco smoking is the principal known preventable exposure associated with any form of AMD

Strong

v1.1 Page 78 of 91

Stryker JE, Beck AD, Primo SA, Echt KV, Bundy L, Pretorius GC, Glanz K (2010) An exploratory study of factors influencing glaucoma treatment adherence with medication taking, prescription refills and appointment keeping to develop an intervention for a specific population. Journal of Glaucoma 19(1): 66-72.Study Purpose & Type




Qualitative study to understand the factors that influence glaucoma treatment adherence with medicationtaking, prescription refills, and appointment keeping

Patients attending two eye clinics located in hospitals in the Southeast United States, aged between 18 and 80 (n = 80)

Patients diagnosed with open angle glaucoma, glaucoma suspect or ocular hypertension

Patients were taking daily doses of topical glaucoma treatments for at least the past year

n/a Participant’s eye condition, prescription medication usage, facilitators and barriers to medication adherence, refill and clinic visit behaviour, medication knowledge and health literacy, psychosocial factors such as self-efficacy, attitudes, and social support

Non-adherent participants less likely to believe their eye doctors spent sufficient time with them; ask if they had any questions; know the benefits of medication; and have someone help them take their medications

Non-adherent participants more likely to have difficulty remembering to take medications and to believe glaucoma would affect their eye sight in the future

Non-adherent glaucoma patients struggle with a variety of issues related to consistent use of glaucoma medicine and routine eye care

Interventions are needed to address these modifiable factors related to glaucoma treatment adherence

Fit for purpose

Non UK study

v1.1 Page 79 of 91

Sukumar S, Spencer F, Fenerty C & Harper R. (2009). The influence of socioeconomic and clinical factors upon the presenting visual field status of patients with glaucoma. Eye. Vol. 23, pt. 5.Study Purpose & Type




A cohort review investigating the relationship between socioeconomic status and the extent of visual field loss in POAG and treated OHT patients at their first presentation

113 glaucoma patients seen between 1995 and 2005 at Manchester Royal Eye Hospital

49 patients were included in affluent group and 64 patients included in socioeconomically deprived group

n/a. ACORN index was used to measure socioeconomic status

Patients in the socioeconomically deprived group presented with more advanced field loss, lower educational attainment (18 vs 98% with no or unknown qualification), and were less aware of glaucoma in the family (27 vs 17%)

The extent of visual field loss in glaucoma patients at first presentation is related to a combination of clinical and socioeconomic factors including the patient's postcode: these findings could be used to target future case-finding resources

Fit for purpose

v1.1 Page 80 of 91

Swamy B, Cumming RG, Ivers R, Clemson L, Cullen J, Hayes MF, Tanzer M, Mitchell P. (2009). Vision screening for frail older people: a randomised trial. British Journal of Ophthalmology, 93(6): 736-741.Study Purpose & Type




A randomised trial assessing the effects of vision screening, and subsequent management of visual impairment, on visual acuity and vision-related quality of life among frail older people

616 men and women from a community in Sydney, Australia aged 70+ years recruited from outpatient aged care services

300 participants received visual assessment while 316 participants formed the control group which received no vision assessment

Comprehensive vision and eye examinations conducted by an optometrist

Distance and near visual acuity (logMAR) and composite scores on the 25-item version of the National Eye Institute Visual Function Questionnaire, both assessed at a 12-month follow-up home visit

There was no significant difference between the intervention and control group

Vision screening by optometrist for frail older people living in the community does not lead to improvements in vision or vision-related quality of life after 1 year

Strong

v1.1 Page 81 of 91

Swenor BK, Bressler S, Caulfield L, West SK (2010) The Impact of Fish and Shellfish Consumption on Age-Related Macular Degeneration. Opthalmology, 13. Study Purpose & Type




A cross-sectional study of dietary and ophthalmologic data to determine the relationship between fish and shellfish consumption and age-related macular degeneration (AMD) status

A random sample participants in the Salisbury Eye Evaluation Study (n = 2520)

n/a Ophthalmic: status of AMD

Dietary: self-reported fish/shellfish consumption based on completion a food frequency questionnaire

Association between weekly fish/shellfish intake and risk of AMD adjusting for risk factors and correlation between eyes

Weekly fish/shellfish consumption not different between specific AMD categories compared with controls

Those with advanced AMD significantly less likely to consume fish/shellfish high in omega-3 fatty acids (OR 0.4; CI 0.2-0.8)

No relationship of AMD with intake of crab and oysters combined

These data support a protective effect of fish/shellfish intake against advanced AMD

Fit for purpose

v1.1 Page 82 of 91

Tan JSL, Wang JJ, Flood V, Mitchell P (2009) Dietary Fatty Acids and the 10-Year Incidence of Age-Related Macular Degeneration The Blue Mountains Eye Study. Arch Ophthalmol. 2009;127(5):656-665.Study Purpose & Type




Population-based cohort study to assess the relationship between baselinedietary fatty acids and 10-year incident age-related maculardegeneration (AMD)

Patients aged 39 years of older living in a Australian town, diagnosed with AMD (n = 3654 at baseline; n = 2454 examined at 5 and/or 10 years later)

n/a 145-item, semi-quantitative food frequency questionnaire (FFQ)

Grading of AMD

Interviewer-administered questionnaire on demographic information, family history, medication history, history of smoking and alcohol use

Relative risk for specific outcomes

Adjusting for age, sex, and smoking, 1 serving of fish per week was associated with reduced risk of incident early AMD

Two servings of nuts per week was associated with reduced risk of incident early AMD

Regularly eating fish, greater consumption of -3 polyunsaturated fatty acids, and low intakes of foods rich in linoleic acid appear to protect against early AMD

Regular consumption of nuts may also reduce AMD risk

Joint effects from multiple factors are suggested

Strong

v1.1 Page 83 of 91

Taylor HR, Vu HTV, McCarty CA, Keefe, JE (2004) The Need for Routine Eye Examinations. Investigative Ophthalmology & Visual Science, 45(8). Study Purpose & Type




Prospective study to determine the incidence and causes of vision loss to assist in the objective determination of the preferred frequency of routine screening for those with normal vision

People aged 40 years or more, living six months in Melbourne (n = 3271 eligible at baseline study; 2594 at five-year follow-up)

n/a Ophthalmic assessment: presenting and best corrected visual acuity, visual field testing; comprehensive eye examination with dilation

Socioeconomic indicators: sociodemographic characteristics; history and current symptoms of eye disease; medical history; and medication use

The 5-year incidence of vision loss was 2.39%

Overall, 24 of those 38 people with vision loss had noticed a change in their vision, and 18 of 24 had attended an eye examination

Only 14 people who had normal baseline examination results developed asymptomatic vision loss over the 5-year period

Frequent routine eye examinations of those with normal results will have a low yield and may not be cost effective

Health promotion messages should target those who notice a change in vision and those at higher risk

Strong

Non-UK study

v1.1 Page 84 of 91

Thornton J, Edwards R, Mitchell P, Harrison RA, Buchan I, Kelly SP. (2005) Smoking and age-related macular degeneration: a review of association. Eye, 19(9): 935-44.Study Purpose & Type




Systematic review of the epidemiological evidence associating smoking with age-related macular degeneration (AMD)


Total of 17 studies: seven cross-sectional studies (n = 23,081); four prospective cohort studies (n = approx. 59,000; approx. numbers due to one study which reported results from two time points); six case–control studies (n = 6703)

n/a Relationship between tobacco smoking and AMD or age-related maculopathy (ARM). Included an estimate of the degree of association (odds ratio or relative risk)

The outcome measure was the presence of ARM or AMD as defined by the investigators of each study

Thirteen studies found a statistically significant association between smoking and AMD

Increased risk of AMD of two- to three-fold in current-smokers compared with never-smokers

Five studies found no association between smoking and AMD

Cigarette smoking is likely to have toxic effects on the retina

In spite of the evidence, there appears to be a lack of awareness about the risks of developing eye disease from smoking among both healthcare professionals and the general public

Strong

v1.1 Page 85 of 91

Tsai T, Robin AL, Smith 3rd JP (2007) An evaluation of how glaucoma patients use topical medications: a pilot study. Trans Am Ophthalmol Soc, 105:29-35.Study Purpose & Type




Pilot study to evaluate how glaucoma patients use topical medications

Patients attending regularly scheduled clinical visits withone of two geographically distinct glaucoma specialists (n = 253)

n/a Questionnaire: current use of eye drops and administration techniques

Demographics: age, gender, self-reported ethnicity

Approx 17% of participants relied on others for the administration of drops

Inadequate vision and manual dexterity were leading causes of dependency

Only 16.3% of self-administering used a mirror

The most common location for administration was bedroom (46.8%), or bathroom (23.4%)

Although most individuals may have little difficulty with the use, storage, and handling of eye drops, a broad variation in reported practices exists

This finding suggests a need for better instruction in eye drop administration

Fit for purpose

v1.1 Page 86 of 91

Walker EA, Schechter CB, Caban A, Basch CE. (2008). Telephone intervention to promote diabetic retinopathy screening among the urban poor . Journal of Preventive Medicine. Vol. 34, pt. 3, pp. 185-91Study Purpose & Type




A randomised controlled trial testing the hypothesis that a tailored telephone intervention in urban minority diabetes populations, offered in English or Spanish, would result in greater screening for retinopathy than a standard print intervention

598 diabetic patients (40% male, mean age = 57 years) of three healthcare centres in the Bronx, NY.

45% of participants were African American and 42% of Hispanic ethnic origin with 23% choosing to receive the intervention in Spanish

A tailored telephone intervention to promote retinopathy screening (intervention group) compared to a standard print intervention (control group) over a 6-month period

Documentation of a dilated fundus examination (DFE) within 6 months was the main outcome

Data on risk perceptions using the Risk Perception Survey for Diabetes were collected pre- and post-intervention

Electronic databases were used to obtain hemoglobin A1c information

There was a 74% increase in retinopathy screening in the telephone (intervention group) versus print (control) group, with no differences by intervention language or by gender

Subjects who had poor diabetes control responded with greater success to telephone interventions

A limited telephone intervention can improve significantly participation in retinopathy screening in a minority, low-income population

Further research is needed to develop effective risk communications to prevent the complications of diabetes

Strong

Non-UK study

v1.1 Page 87 of 91

Wilson R, Walker A, Dueker DK, Pitts-Crick R. (1982) Risk factors for rate of progression of glaucomatous visual field loss. Archives of Ophthalmology 100: 737-742.Study Purpose & Type




Study to examine factors affecting the progression of visual field loss caused by Glaucoma

Patients with bilateral open angle glaucoma (n = 57)

n/a Visual field loss at initial examination

Visual field loss at follow-up

Patients with marked visual field loss at initial examination deteriorated 11.7 times faster than patients without initial field loss

Family history of glaucoma, gender, and initial registration intraocular pressure

important prognostic factors for progressive visual field loss

Age and systemic blood pressure not

found to affect rate of visual field loss

Fit for purpose (but now rather dated: however, widely cited and not contradicted)

v1.1 Page 88 of 91

Wolfs RC, Klaver CC, Ramrattan RS, van Duijn CM, Hofman A, de Jong PT (1998) Genetic risk of primary open-angle glaucoma: Population-based familial aggregation study. Arch Ophthalmol, 116(12): 1640-5.Study Purpose & Type




Population based study to examine familial aggregation of primary open angle glaucoma in a general population and to determinethe absolute and relative risks for first-degree relatives

First-degree relatives of patients with glaucoma(n = 48) and control subjects (n = 155) from thepopulation-based Rotterdam Study

n/a Ophthalmic: intraocular pressure; vertical cup-disc ratio; and the presence of glaucoma

Other risk factors: presence of diabetes mellitus or hypertension

Covariates: age and gender

Prevalence of glaucoma 10.4% in siblings of patients, 1.1% in offspring of patients, 0.7% in siblings of controls, 0% in offspring of controls

Risk ratio for glaucoma in relatives of patients vs. controls was 9.2 (95% CI = 1.2-73.9)

Population-attributable risk of glaucoma 16.4%

Relatives of patients with glaucoma have a strongly increased risk of glaucoma

Enlarged cup-disc ratio, not intraocular pressure, the earliest and most prominent feature of familial aggregation

Further studies needed to disentangle genetic components of increased familial risk

Strong

Non -UK study

v1.1 Page 89 of 91

Wormald RP, Basauri E, Wright LA, Evans JR (1994) The African Caribbean Eye Survey: risk factors for glaucoma in a sample of African Caribbean people living in London. Eye, 8(3): 315-20.Study Purpose & Type




Cross-sectional study to estimate the prevalence of and risk factors for chronic glaucoma in a sample of African Caribbean people over 35 years

African and Caribbean people living in the London borough of Haringey (n = 873)

Community-based survey clinics at six different sites in Haringey

n/a Socio-economic: personal and family medical and ocular history, migration history; and demographic data

Blood pressure and blood sugar

Ophthalmologic: binocular and uniocular visual acuity; suprathreshold visual fields, applanation tonometry, lens opacity; vertical cup-to-disc ratio; and fundus photography

32 definite cases of glaucoma were identified, a prevalence of 3.9%

Comparison with a previous study revealed a relative risk for glaucoma for Haringey blacks compared with Irish whites of 3.7

Significant risk factors for glaucoma included age, African birthplace and darker skin colour

Study provides strong evidence that the 4 times greater risk of glaucoma estimated for American blacks compared with whites applies equally to the United Kingdom population

Community-based facilities are required to raise awareness of the risk among this ethnic minority in this country and case finding resources should be provided

Fit for purpose

UK study

v1.1 Page 90 of 91

Zhang X, Norris SL, Saadine J, Chowdhury FM, Horsley T, Kanjilal S, et al. (2007) Effectiveness of interventions to promote screening for diabetic retinopathy. American Journal of Preventive Medicine, 33(4): 318-35.Study Purpose & Type




Systematic review to assess the effectiveness of interventions aimed to increase retinal screening among people with diabetes


Interventions used to promote screening for diabetic retinopathy (DR) in any language and with any study design

12 randomized controlled trials (RCT); four nonrandomized studies; 32 pre–post studies (n = 162,157)

Patient focused: awareness of DR; adherence to recommendations Flexibility of providers and practicesSystem-focused: access to health care; availability of a delivery system; better records; creation of a screening system; improved services in a resource-poor agency

Primary measure: relative risk (RR)

Four of five RCTs focusing on patients demonstrated interventions significantly increased screening

Five RCTs with a focus on the system all demonstrated significant increases in screening

Non-RCTs, which included also generally demonstrated positive effects

Provider focused: adherence to recommendations reduced negligence of practices.Increasing patient knowledge of diabetic retinopathy, improving provider and practice performance, and improving healthcare system infrastructure and processes, can significantly increase screening for diabetic retinopathy

Strong

v1.1 Page 91 of 91

evaluating strategies to address eye health inequalities ... · web viewduke sas, colagiuri s,...

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