How to defuse a demographic time bomb: the way forward?

Amoaku, Winfried; Barnes, Beth; Cassels-Brown, Andy; Chang, Bernard; Harcourt, Jane; Shickle, Darren; Spencer, Anne Fiona; Vernon, S A; MacEwen, Carrie

doi:10.1038/eye.2017.114

Cited by 24 publications

(15 citation statements)

References 22 publications

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“…In 2016, UK lead clinicians were surveyed by email using the RCOphth database; no department reported offering ISBCS to routine patients from 42 responses, and only 14% (6/42) reported that they would offer ISBCS to individual patients according to specific need (unpublished data—personal communication (A. Azuara-Blanco). The same finding was reported from the RCOphth Way Forward project which requested phone interviews with consultants nominated as leading cataract services in their units; 50 consultants from across the UK were interviewed (representing 50/142 UK NHS eye departments) and none were found to be offering ISBCS routinely [ 7 ].…”

Section: Discussionmentioning

confidence: 72%

“…If we are to mitigate the effects of the demographic time bomb [ 7 ], encouraging providers to offer ISBCS potentially offers a more cost-effective and sustainable pathway, with reduced outpatient visits, enhanced operating theatre efficiency through shorter surgical turnaround times between operations, and reduced carbon footprint [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 7, immediate sequential bilateral cataract surgery in the UK: Current practice and patient selection

Donachie

Cassels-Brown

Liu

et al. 2020

Eye

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Background Cataract extraction is the most frequently performed surgical intervention in the world and demand is rising due to an ageing demography. One option to address this challenge is to offer selected patients immediate sequential bilateral cataract surgery (ISBCS). This study aims to investigate patient and operative characteristics for ISBCS and delayed bilateral cataract surgery (DSCS) in the UK. Methods Data were analysed from the Royal College of Ophthalmologists’ National Ophthalmology Database Audit (NOD) of cataract surgery. Eligible patients were those undergoing bilateral cataract extraction from centres with a record of at least one ISBCS operation between 01/04/2010 and 31/08/2018. Variable frequency comparison was undertaken with chi-square tests. Results During the study period, 1073 patients had ISBCS and 248,341 DSCS from 73 centres. A higher proportion of ISBCS patients were unable to lie flat (11.3% vs. 1.8%; p < 0.001), unable to cooperate (9.7% vs. 2.7%; p < 0.001); underwent general anaesthesia (58.7% vs. 6.6% ( p < 0.001)); had brunescent/white/mature cataracts (odds ratio (OR) 5.118); no fundal view/vitreous opacities (OR 8.381); had worse pre-operative acuity 0.60 LogMAR ISBCS vs. 0.50 (first) and 0.40 (second eye) DSCS and were younger (mean ages, 71.5 vs. 75.6 years; p < 0.001). Posterior capsular rupture (PCR) rates adjusted for case complexity were comparable (0.98% ISBCS and 0.78% DSCS). Conclusions ISBCS was performed on younger patients, with difficulty cooperating and lying flat, worse pre-operative vision, higher rates of known PCR risk factors and more frequent use of general anaesthesia than DSCS in centres recorded on NOD.

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Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 7, immediate sequential bilateral cataract surgery in the UK: Current practice and patient selection

Donachie

Cassels-Brown

Liu

et al. 2020

Eye

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“…. The first application of this system will be in the rapid access "virtual" clinics widely used for macular disease triage in the UK, 207 while the longer-term goal will be the use of such a system in community settings. Prior to this, further validation of the system will be required and multi-center prospective clinical trials are planned to begin recruitment in 2019.…”

Section: Image-based Classificationmentioning

confidence: 99%

Deep learning in ophthalmology: The technical and clinical considerations

Ting

Peng

Varadarajan

et al. 2019

Progress in Retinal and Eye Research

375

237

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“…The volume of outpatient appointments required (> 1 million/year in the UK alone 3 ) is placing glaucoma services under increasing strain: as evidenced by a growing appointment backlog 4 and instances of avoidable sight loss due to treatment delays 5 , 6 . Globally, the challenge of glaucoma management is only likely to intensify over the coming decades 7 , with aging societies 8 , 9 and calls for increased monitoring 1 and earlier detection 10 . Furthermore, hospital assessments cannot be performed with the frequency required for best patient care.…”

Section: Introductionmentioning

confidence: 99%

Glaucoma Home Monitoring Using a Tablet-Based Visual Field Test (Eyecatcher): An Assessment of Accuracy and Adherence Over 6 Months

Jones

Campbell

Callaghan

et al. 2021

American Journal of Ophthalmology

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Purpose To assess accuracy and adherence of visual field (VF) home-monitoring in a pilot sample of glaucoma patients. Design Prospective longitudinal feasibility and reliability study. Methods Twenty adults (median 71 years) with an established diagnosis of glaucoma were issued a tablet-perimeter (Eyecatcher), and were asked to perform one VF home-assessment per eye, per month, for 6 months (12 tests total). Before and after home-monitoring, two VF assessments were performed in-clinic using Standard Automated Perimetry (SAP; 4 tests total, per eye). Results All 20 participants could perform monthly home-monitoring, though one participant stopped after 4 months (Adherence: 98%). There was good concordance between VFs measured at home and in the clinic ( r = 0.94, P < 0.001). In 21 of 236 tests (9%) Mean Deviation deviated by more than ±3 dB from the median. Many of these anomalous tests could be identified by applying machine learning techniques to recordings from the tablets’ front-facing camera (Area Under the ROC Curve = 0.78). Adding home-monitoring data to 2 SAP tests made 6 months apart reduced measurement error (between-test measurement variability) in 97% of eyes, with mean absolute error more than halving in 90% of eyes. Median test duration was 4.5 mins ( Quartiles : 3.9 – 5.2 mins). Substantial variations in ambient illumination had no observable effect on VF measurements ( r = 0.07, P = 0.320). Conclusions Home-monitoring of VFs is viable for some patients, and may provide clinically useful data.

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How to defuse a demographic time bomb: the way forward?

Cited by 24 publications

References 22 publications

The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 7, immediate sequential bilateral cataract surgery in the UK: Current practice and patient selection

The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 7, immediate sequential bilateral cataract surgery in the UK: Current practice and patient selection

Deep learning in ophthalmology: The technical and clinical considerations

Glaucoma Home Monitoring Using a Tablet-Based Visual Field Test (Eyecatcher): An Assessment of Accuracy and Adherence Over 6 Months

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