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Research Interests: Ophthalmology, Surgery, Educational Measurement, Archives, Evaluation, and 12 moreTreatment, Medicine, Cataract surgery, Humans, Graduate medical education, Optometry and Ophthalmology, Clinical Competence, Competency Based Education, Phacoemulsification, Task Performance and Analysis, Video Recording, and internship and residency
Research Interests: Materials Science, Ophthalmology, Immunology, Optical coherence tomography, Medicine, and 15 moreVisual acuity, Humans, Female, Male, Clinical Sciences, Eye, Aged, Middle Aged, Optometry and Ophthalmology, Retrospective Studies, Prognosis, Macular Hole, Epiretinal Membrane, Vitrectomy, and Severity of Illness Index
Research Interests: Optometry, Ophthalmology, Educational Measurement, Australia, Microsurgery, and 10 moreMedicine, Teaching, Humans, Graduate medical education, Citation, Clinical Sciences, Optometry and Ophthalmology, Public health systems and services research, Clinical Competence, and Indian Journal of Clinical and Experimental Ophthalmology
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Background Surgery for established cataract is highly cost-effective and uncontroversial, yet uncertainty remains for individuals about when to proceed and when to delay surgery during the earlier stages of cataract. Objective We aimed to... more
Background Surgery for established cataract is highly cost-effective and uncontroversial, yet uncertainty remains for individuals about when to proceed and when to delay surgery during the earlier stages of cataract. Objective We aimed to improve decision-making for cataract surgery through the development of evidence-based clinical tools that provide general information and personalised risk/benefit information. Design We used a mixed methodology consisting of four work packages. Work package 1 involved the development and psychometric validation of a brief, patient self-reported measure of visual difficulty from cataract and its relief from surgery, named Cataract Patient-Reported Outcome Measure, five items (Cat-PROM5). Work package 2 involved the review and refinement of risk models for adverse surgical events (posterior capsule rupture and visual acuity loss related to cataract surgery). Work package 3 involved the development of prediction models for the Cat-PROM5-based self-r...
Research Interests: Cataract surgery and Harm
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Surgical training in ophthalmology has altered significantly over the last 25 years as a result of changes in technology, teaching methodology, and the recognition of the need for better structure and supervision. Along with this have... more
Surgical training in ophthalmology has altered significantly over the last 25 years as a result of changes in technology, teaching methodology, and the recognition of the need for better structure and supervision. Along with this have evolved changes in curriculae and also in service delivery of our rapidly advancing specialty. Initial abandonment of time-based training has now reached the point of a slightly uneasy combination of a time- and competency-based structure, which will find firmer foundations in the near future. Simulation training and recognition of time spent in practising surgical skills will be important issues for future training programmes.
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Nick Astbury Consultant Ophthalmic Surgeon, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich NR4 7UY, UK.
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To study the outcomes of pediatric cataract surgeries in children operated on in the Copperbelt Province of Zambia and the barriers to accessing surgery. All children who had congenital, developmental, and traumatic cataracts operated on... more
To study the outcomes of pediatric cataract surgeries in children operated on in the Copperbelt Province of Zambia and the barriers to accessing surgery. All children who had congenital, developmental, and traumatic cataracts operated on by lens aspiration, primary posterior capsulotomy, and anterior vitrectomy with posterior chamber intraocular lens implantation from 2012 to 2013 and followed up beyond 6 months were studied. Each child underwent a comprehensive preoperative evaluation. An active, assisted follow-up was done and parents were asked about reasons for delay between presentation and surgery. One hundred two eyes of 70 children met the inclusion criteria of the study. Preoperatively, 76 of 77 (98.7%) eyes in the congenital and developmental cataract group had presenting visual acuity of worse than 6/60. This improved postoperatively, with 19 (29.7%) eyes having best corrected visual acuity (BCVA) of better than 6/18, 23 (35.9%) having BCVA of 6/24 to 6/60, and 22 (34.4%) having BCVA of worse than 6/60. Older age (P = .005), better preoperative vision (P = .045) at presentation, unilaterality (P = .012), and delay between presentation and surgery (P = .004) were predictors of a better postoperative outcome. On multivariate analysis, only age was significant (P = .025). Distance and cost of travel and surgery were the causes of delay in presentation. In the patients with traumatic cataracts, 17 of 25 (68%) had BCVA of better than 6/18, 6 (24%) had BCVA between 6/24 and 6/60, and 2 (8%) had BCVA of worse than 6/60 at the 6-month follow-up. The most common causes of injury were being struck by sticks and stones (10 children, 25%). Visual outcomes after pediatric cataract surgery in Zambia were comparable and satisfactory. Cost of treatment was a barrier, but delay did not adversely affect outcome. [J Pediatr Ophthalmol Strabismus. 2016;53(5):311-317.].
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The use of the Oxford retro-illumination camera in documenting cataract is now well established. Repeatability has been shown to be good. This article describes its use in photographing the anterior segment of the eye.
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To determine whether intraocular lens (IOL) exchange with insertion of a sulcus-fixated IOL is an effective treatment for the management of pseudophakic negative dysphotopsia. Department of Ophthalmology, Stoke Mandeville Hospital,... more
To determine whether intraocular lens (IOL) exchange with insertion of a sulcus-fixated IOL is an effective treatment for the management of pseudophakic negative dysphotopsia. Department of Ophthalmology, Stoke Mandeville Hospital, Buckinghamshire, United Kingdom. Case series. Participants in the study were recruited prospectively from the clinic at the time of diagnosis or retrospectively from the operating room logs by identifying all patients who had IOL exchanges over a 4-year period (2009 to 2012). Five eyes of 5 women with negative dysphotopsia were treated with IOL exchange and replacement with a 3-piece IOL (Acrysof MA60AC) inserted in the ciliary sulcus. All patients had a resolution of the negative dysphotopsia symptoms. One patient had primary insertion of a sulcus IOL in the fellow eye and did not develop negative dysphotopsia symptoms. Intraocular lens exchange with insertion of a 3-piece IOL in the ciliary sulcus appears to be a safe and effective treatment for the man...
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To report a case of progressive vitreomacular traction, definitive optical coherence tomography evidence of established vitreomacular traction, and subsequent spontaneous resolution with posterior vitreous detachment occurrence. Case... more
To report a case of progressive vitreomacular traction, definitive optical coherence tomography evidence of established vitreomacular traction, and subsequent spontaneous resolution with posterior vitreous detachment occurrence. Case report and literature review. This study involved a patient presenting to the Retina Clinic at Stoke Mandeville Hospital. Symptomatic improvement after posterior vitreous detachment. Dynamic vitreomacular traction should be suspected in cases of fluctuating central visual disturbance, particularly when associated with accommodation and downward head posture. The authors discuss the possible influence of accommodation and head position.
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Research Interests: Ophthalmology, Educational Measurement, Microsurgery, Skill Acquisition, Teaching, and 15 moreProspective studies, Humans, Female, Male, Graduate medical education, Clinical Sciences, Optometry and Ophthalmology, Adult, Public health systems and services research, Corneal transplantation, Clinical Competence, Task Performance and Analysis, Motor Skills, internship and residency, and Suture techniques
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To determine whether aspiration of lens epithelial cells (LECs) from under the anterior capsule reduces postoperative contraction of the capsulorhexis aperture. Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, United Kingdom. This... more
To determine whether aspiration of lens epithelial cells (LECs) from under the anterior capsule reduces postoperative contraction of the capsulorhexis aperture. Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, United Kingdom. This prospective randomized observer-masked study comprised 100 patients who had routine phacoemulsification by the same surgeon at a district general hospital in the United Kingdom. The postoperative changes in capsulorhexis apertures and anterior capsule opacification (ACO) between Group A (aspiration of LECs) and Group B (control) were compared. Digital retroillumination images of the capsulorhexis aperture were taken 1 week and 3 months postoperatively. The area of capsulorhexis aperture was determined with computer software, and capsule opacification was graded subjectively. Three months postoperatively, the mean decrease in capsulorhexis aperture was 1.9% in Group A and 5.6% in Group B (P = .02). The ACO at 3 months was grade 2 in 44% of eyes in Group A and in 61% in Group B (P = .13). Aspiration of LECs from the anterior capsule was a safe procedure that reduced capsulorhexis aperture contraction 3 months after cataract surgery.
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The use of the Oxford retro-illumination camera in documenting cataract is now well established. Repeatability has been shown to be good. This article describes its use in photographing the anterior segment of the eye.