Persistent OHT may occur after intravitreal anti-VEGF injection in patients with no previous diagnosis of glaucoma or OHT. OHT may persist across several visits and patients may require IOP-lowering therapy. Sustained elevation in IOP usually occurs after multiple injections.

A Telemedical Approach to the Scre e n i n g of Diabetic Retinopathy: Digital Fundus P h o t o g r a p h y O R I G I N A L A R T I C L E O B J E C T I V E -The importance of screening for diabetic retinopathy has been established, but the best method for screening has not yet been determined. We re p o rt on a trial of assessment of digital photographs by telemedicine compared with standard retinal photographs of the same fields and clinical examination by ophthalmologists. RESEARCH DESIGN AND METHODS-A total of 129 diabetic inpatients were s c reened for diabetic retinopathy by slit-lamp biomicroscopy perf o rmed by an ophthalmologist and by two-field 50° non-stereo digital fundus photographs assessed by six screening centers that received the images by electronic mail. Conventional 35-mm transparencies of the same fields as the digital photographs were assessed by a retinal specialist and served as the re fe rence method for detection of diabetic re t i n o p a t h y. Slit-lamp biomicroscopy was the re f e re n c e method for the detection of macular edema. R E S U LT S -The prevalence of any form of diabetic retinopathy was 30% (n = 35); of sightt h reatening retinopathy including macular edema, the prevalence was 6% (n = 7). The assessment of digital images by the six screening centers resulted in a median sensitivity of 85% and a median specificity of 90% for the detection of moderate nonproliferative or sight-thre a t e ning diabetic re t i n o p a t h y. Clinically significant macular edema (n = 4) was correctly identified in 15 of the 24 grading re p o rts. An additional seven re p o rts re f e rred the patients for furt h e r investigation because of concurrent diabetic re t i n o p a t h y.C O N C L U S I O N S -Te l e s c reening for diabetic retinopathy by an assessment of two-field 50°n o n -s t e reo digital images is a valid screening method. Although detection of clinically significant macular edema using biomicroscopy is superior to digital or standard non-stereo photographs, only few patients with sight-threatening diabetic retinopathy are missed. E m e r g i n g T r e a t m e n t s a n d T e c h n o l o g i e s Diabetes Care 346DIABETES CARE, VOLUME 23, NUMBER 3, MARCH 2000 Telemedical screening of diabetic retinopathyThe 65 patients who did not part i c ipate were older (59.0 ± 16.0 years), had a longer duration of diabetes (17.6 ± 12.4 years), and had more severe re t i n o p a t h y (43% no, 33% mild or moderate, and 24% s i g h t -t h reatening diabetic retinopathy). The p ro p o rtion of men (50%) and patients with type 2 diabetes (58%) did not differ fro m the included patients. These patients were examined by an ophthalmologist only. Experimental protocolAfter the assessment of best corrected visual a c u i t y, each patient was screened for the p resence of diabetic retinopathy after dilation of pupils (tropicamide 1%) and subsequent slit-lamp biomicroscopy by an experienced ophthalmologist. During the study period, six senior ophthalmologists, not specializing in diabetic re t i n o p...

Context:The provision of ocular surgical interventions for poorer, less educated populations is increasing as a result of increased globalization and outreach. However, these populations still have trouble understanding surgical concepts and are not always fully informed decision makers.Aims:We aimed to test the effect that a multimedia addition to a traditional verbal informed consent would have on patient comprehension of relatively difficult cataract surgical concepts.Settings and Design:We conducted a randomized controlled trial with relatively uneducated patients reporting to a private surgical hospital in Chennai, India. 47 patients were placed into the intervention group and 50 patients were placed into the control group.Materials and Methods:The intervention group was presented with a scripted verbal informed consent as well as a 3-fold pamphlet and a presentation with a 3-dimensional model of the eye. The control group was only presented with a scripted verbal informed consent. The two groups were tested using an 11 item “True/False/I don’t know” quiz directly before the informed consent, directly after the informed consent, and one-day postoperatively.Statistical Analysis Used:Scores on the quiz were compared across groups and time-points using paired t-tests.Results:Patients in the both groups showed a significant improvement in scores between pre- and post-informed consent quizzes (P value on the order of 10-6) and the improvement in scores was significantly greater in the intervention group than the control group (P value on the order of 10-16). There was no significant difference observed in either group with regards to the change in scores between post-informed consent and post-operative quizzes.Conclusion:Multimedia aids in addition to a standard informed consent process are effective in improving patient comprehension even for patients with low literacy and limited knowledge of surgical interventions.

Purpose-To determine whether a visual aid improves the understanding and retention of information presented during informed consent for rural, indigent patients presenting for cataract surgery.Materials and Methods-This was a randomized, unmasked, interventional study. We recruited patients who presented to the Hande Surgical Hospital in Chennai, India, for cataract surgery. Patients were randomized into two groups: verbal consent alone (group A) and verbal consent plus a poster (group B). Both groups completed an 11-question true/false quiz immediately before and after informed consent and one day after surgery.Results-A total of 60 patients were recruited for the study, with 30 randomly assigned to each group; 23 patients from group A and 17 from group B completed the study. Informed consent improved patient scores in both groups; however, group B had significantly higher mean scores on postoperative day 1 (7.4 vs 8.7, P = 0.005) and significantly greater improvement in mean scores from pre-informed consent to postoperative day 1 (1.3 vs 3.6, P = 0.002).Conclusions-Informed consent improves patient understanding of cataract surgery. Using a visual aid during informed consent for cataract surgery improves understanding and retention of information more than verbal consent alone in a rural South Indian population.Multiple barriers to high-quality care exist for millions of indigent patients with pressing medical conditions. [1][2][3][4] Ineffective communication between health care providers and patients is a major factor in reduced care. [5][6][7] Roadblocks to effective communication can include limited formal education, illiteracy, and misinformation or misunderstanding among the population being served regarding medical interventions. 5,7 Informed consent is a critical component of invasive medical procedures, helping to establish a healthy doctor-patient relationship by educating patients about the methods, risks, and benefits of procedures. 8 Moseley et al 9 examined the use of a poster and video presentation combined with a verbal informed consent in a highly educated population and demonstrated a significant increase in patient understanding of cataract surgery. In another study, the use of written pamphlets in addition to verbal discussion prior to cataract surgery showed an increase in information retention among patients. 10 Methods used to communicate with patients in developed countries such as graphic tools and electronic multimedia-based programs may not be applicable to indigent populations in the developing world. 11,12 In addition, written pamphlets and electronic programs can be prohibitively expensive in financially limited clinics. We aimed to determine whether a poster presentation combined with a verbal informed

It may be safe to use a topical CAI in patients who report a history of a sulfa allergy. Patients with medication allergies of any kind may be more likely to develop allergic reactions to other, unrelated drug classes.