Showing papers by "Paul P. Lee published in 2010"

Vision-related quality of life in persons with unilateral branch retinal vein occlusion using the 25-item National Eye Institute Visual Function Questionnaire

Abstract: Aim To evaluate vision-related quality of life in persons with branch retinal vein occlusion (BRVO) using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Design Observational, cross-sectional, interviewer-administered study. Methods 46 patients with unilateral BRVO were included in this study. Scores on the VFQ-25 were analysed and converted to scaled scores per NEI VFQ-25 algorithms. Clinical data including age, gender, employment status, living arrangements, visual acuity, number of systemic diseases and duration of BRVO were also recorded. Subscale results were compared with previously published data, and subgroup analyses were performed. Results Mean adjusted subscale responses among BRVO patients were higher (except for ocular pain) than known averages in patients with diabetic retinopathy, central retinal vein occlusion, age-related macular degeneration and low vision, but lower than known averages in a reference group of people without ocular disease. Subscale responses correlated significantly with visual acuity in the involved eye. This observation held true in eight of 12 subscales, even in patients who maintained vision of 20/25 or better in the uninvolved eye. The General Health subscale and number of systemic diseases correlated significantly with both the General Vision and Peripheral Vision subscale scores. There was no correlation between subscale responses and age. Conclusions BRVO is a retinal vascular disease that is associated with a decrease in vision-related quality of life as determined by the VFQ-25. A decrease in VFQ-25 score is correlated with involved eye visual acuity, even when good visual acuity is maintained in the uninvolved eye.

Comparative analysis of six genome sequences of three novel picornaviruses, turdiviruses 1, 2 and 3, in dead wild birds, and proposal of two novel genera, Orthoturdivirus and Paraturdivirus, in the family Picornaviridae.

Abstract: In this territory-wide molecular epidemiology study of picornaviruses, involving 6765 dead wild birds from 201 species in 50 families over a 12 month period, three novel picornaviruses, turdiviruses 1, 2 and 3 (TV1, TV2 and TV3), were identified from birds of different genera in the family Turdidae. In contrast to many other viruses in birds of the family Turdidae or viruses of the family Picornaviridae, TV1, TV2 and TV3 were found exclusively in the autumn and winter months. Two genomes each of TV1, TV2 and TV3 were sequenced. Regions P1, P2 and P3 of the three turdiviruses possessed, respectively, <40, <40 and <50 % amino acid identities with those of other picornaviruses. Moreover, P1, P2 and P3 of TV1 also possessed, respectively, <40, <40 and <50 % amino acid identities with those of TV2 and TV3. Phylogenetic analysis revealed that TV1, TV2 and TV3 were distantly related to members of the genus Kobuvirus. Among the three turdiviruses, TV2 and TV3 were always clustered together, with high bootstrap supports of 1000. The genomic features of TV2 and TV3 were also distinct from TV1, including lower G+C contents, shorter leader protein and a preference for codon sequence NNT rather than NNC for amino acids that can use either NNT or NNC as codons (P<0.001 by χ 2-test). Based on our results we propose two novel genera, Orthoturdivirus for TV1, and Paraturdivirus for TV2 and TV3, in the family Picornaviridae. The type of internal ribosomal entry site for TV1, TV2 and TV3 remains to be determined.

The Cost of Visual Impairment: Purposes, Perspectives, and Guidance

Abstract: The Association for Research in Vision and Ophthalmology (ARVO) Workshop on the Economic Burden of Vision Loss was held on September 17, 2007, in Vancouver, British Columbia, Canada, under the auspices of ARVO and the International Agency for the Prevention of Blindness. The workshop’s goal was to develop consensus on the best practices for measuring the burden of vision loss. The meeting was organized around a discussion of papers that had recently been published describing various methods of calculating the burden associated with vision loss. A result of the workshop is the publication of the results of the consensus-building process that was begun at the meeting and continued with correspondence and revisions of the statements regarding consensus after the meeting.

The Role of Vision in Academic School Performance

Abstract: Purpose: To determine whether presenting distance visual acuity is related to subsequent academic school performance in Singaporean children between 9 to 10 years of age.Methods: Singapore children (n = 1143 children) were examined during their visits at ages 9 to 10 years (grades 3 to 4) as part of the Singapore Cohort Study of the Risk Factors for Myopia (SCORM) longitudinal study. Each child underwent an annual comprehensive eye examination, including the assessment of presenting logarithm of the minimum angle of resolution (LogMAR) distance visual acuity (VA). The individual marks of a nation-wide standard examination in grade 4 were used as the outcome measure for academic school performance. Children with any known eye disease, (such as media opacities) were excluded from the analysis.Results: The mean presenting distance VA of the better eye was 0.10 and 0.08 when the children were in grades 3 and 4, respectively. There was a statistically significant difference for mean presenting VA with 9 and 10...

The methodology of visual field testing with frequency doubling technology in the National Health and Nutrition Examination Survey, 2005-2006.

Abstract: Purpose: To describe the frequency doubling technology (FDT) methodology to measure visual field loss in the National Health and Nutrition Examination Survey and to evaluate data reliability.Methods: Participants aged 40 years and older were eligible (n = 2,529) for 2 visual field tests per eye performed with the Humphrey Matrix N-30-5 screening test. Visual field loss was determined using a 2-2-1 algorithm requiring 2 complete tests per eye, with at least 2 abnormal field results in each test, and 1 common abnormal field.Results: Response rate was 86.2%. Time constraints were the main reason for no exam (55.6%). Median times were: single test, 37 seconds; entire exam, 9.1 minutes. When defining reliability based on ≤ 1/3 blind spots, ≤ 1/3 false positive tests, and technician noted proper fixation, 80.1% of examined adults had 2 reliable tests for both eyes; an additional 13.4% had 2 reliable tests for 1 eye. Increasing age, decreasing visual acuity, and the presence of self-reported glaucoma resulted in...

Primary care provider views of the current referral-to-eye-care process: focus group results.

Abstract: Purpose. To understand the barriers facing primary care providers (PCPs), including nurse practitioners (NPs) and physician assistants (PAs), in the current referral-to-eye-care process and to solicit suggestions from PCPs on how to improve the current referral system. Methods. Four focus groups were conducted with a total of 17 PCPs: two groups with physicians (MDs): one in a rural setting and one in an academic medical center setting and one group of NPs and one of PAs, both in an academic setting. All discussions were audiotaped and transcribed, and both authors performed content analysis of the transcripts with the assistance of qualitative software. Results. The most frequently cited referral barriers included: (1) poor communication from eye care providers (ECPs), (2) patients' lack of finances/insurance coverage, and (3) difficulty in scheduling an eye care appointment. Suggestions made in all groups on ways to improve the current referral system included (1) implementing electronic medical records (EMRs), (2) receiving better communication/feedback from ECPs, (3) having ophthalmologists hold clinic days in primary care facilities, and (4) performing retinal scans in primary care clinics. We found few differences between the opinions of MDs and those of NPs and PAs. Conclusions. PCPs desire change(s) in the current referral-to-eye-care system. Better communication between PCPs and ECPs, further implementation of EMRs, and increasing eye screening in primary care clinics were common themes. Implementing specific suggestions, such as modernizing medical record systems, may help to increase eye care utilization among patients at high risk for advancing eye disease and vision loss.

Documentation of Conformance to Preferred Practice Patterns in Caring for Patients With Dry Eye

Abstract: Objective To evaluate documentation of physician evaluations of patients with dry eye for the presence of key elements as defined in the American Academy of Ophthalmology Summary Benchmarks for Preferred Practice Patterns. Methods One hundred thirty-one medical records of patients seen at the Duke Eye Center from January 1998 to July 2008 were reviewed relative to both the dry eye preferred practice patterns benchmarks for 1998 (all patients) and 2003 (for those seen between 2004 and 2008). Overall total score and subsection scores were calculated for all patients, as well as by specialty provider types and by type of medical record (electronic vs paper). Results Of all records reviewed, 84.8% were for women and the mean (SD) age of all patients was 60.3 (20.8) years. On average, 66.4% of the initial history key elements, 77.3% of the initial physical examination key elements, 40.0% of care management key elements, and 67.9% of patient education key elements were documented. The physical examination scores were highest in the “other” subspecialty ophthalmologist group compared with the comprehensive ophthalmologist group ( P = .03) and cornea specialists ( P = .02). The physical examination scores were 87% in the electronic medical record and 75% in the standard paper medical record ( P Conclusions In an academic practice, the process of care delivery for dry eye does conform to the American Academy of Ophthalmology Preferred Practice Patterns in some areas; however, there is room for improvement especially in the areas of patient education and care management. Additional data are needed from other practice settings to further evaluate the quality of dry eye care.

Resequencing microarray for detection of human adenoviruses in patients with community-acquired gastroenteritis: a proof-of-concept study.

Abstract: Viral gastroenteritis is one of the most common infectious diseases worldwide, causing significant morbidity and mortality. The main groups of viruses associated with gastroenteritis in humans include rotaviruses, adenoviruses, noroviruses and astroviruses. Traditionally, electron microscopic examination of stool specimens has been the main way to confirm the aetiology of viral gastroenteritis, as most of these viruses are difficult to culture. However, electron microscopic examination is labour-intensive and expensive. Although direct antigen detection is available for rotaviruses and adenoviruses, no comprehensive set of monoclonal antibodies against the other viruses is available. Nucleic acid detection can potentially overcome the above problems, and strategies such as multiplex PCR have been devised and validated to detect nucleic acids of multiple viruses simultaneously.

Integrating direct electronic collection of data from patients into the process of care for eye care professionals.

Abstract: Enabling collection of clinical data directly from patients has the potential to increase data accuracy and augment patient engagement in the care process. Most patient data entry systems have been created independent of electronic health records, and few studies have explored how patient entered data can be integrated in the documentation of a clinical encounter. In this paper we describe a formative evaluation study using three different methodologies through which we identified requirements for direct data entry by patients and the subsequent incorporation of these data into the documentation process. The greatest challenges included ensuring confidentiality of records between patients, capturing medication histories from patients, displaying and distinguishing new and previously entered data for provider review, and supporting patient educational needs. The resulting computer tablet-based data collection tool has been deployed to 30 primary care optometry practices where it is successfully used to document care for patients with glaucoma.

Conformance with preferred practice patterns in caring for children with esotropia.

Abstract: PURPOSE To evaluate documentation of the initial evaluation in patients with esotropia, with respect to history, physical examination, care management, and patient education, for the presence of key elements as defined in the American Academy of Ophthalmology's Summary Benchmarks for Preferred Practice Patterns METHODS Two hundred charts of patients seen at the Pediatrics Service at the Duke Eye Center for an initial diagnosis of esotropia were reviewed relative to both the 2002 (all patients) and 2007 (for those seen in 2007) Preferred Practice Patterns benchmarks for esotropia Documentation of key elements as defined in the Preferred Practice Patterns was recorded RESULTS The average total score was 858% for all evaluations On average, 636% of the initial history key elements, 996% of the initial physical examination key elements, and 942% of the care management and patient education key elements were documented For evaluations performed in 2007 and scored according to the 2007 Preferred Practice Patterns, scores were similar, except that the physical examination subset score average decreased to 903% and the family history documentation score increased to 455% CONCLUSION In an academic practice, the process quality of care for strabismus often conforms well to professional practice patterns However, there are opportunities for improvement in the documentation of key history elements Additional data are needed from other practice settings and for other conditions to assess the quality of eye care for children