PURPOSE: To determine whether a biometry training course could improve refractive outcomes of patients undergoing manual small-incision extracapsular cataract surgery (SICS). MATERIALS AND METHODS: This was a prospective, interventional, cohort study at the Pacific Eye Institute, Fiji. SICS refractive outcomes were evaluated before and after a structured biometry teaching course. Eyes that underwent evaluation and subsequent SICS with placement of a posterior chamber intraocular lens (IOL) were included. Axial length measurements were obtained using A-scan applanation ultrasound and keratometry with a handheld keratometer. Main outcome measures included mean absolute prediction error of IOL calculations, percentage of eyes within ±0.5 D and ±1.0 D of intended spherical equivalent, and proportion of eyes with ≥6/18 uncorrected visual acuity. RESULTS: A total of 240 eyes were analyzed: 120 eyes before and 120 eyes after the structured biometry training. The mean absolute prediction error was 50% lower following the training (1.13 ± 0.84 D pre vs. 0.56 ± 0.44 D post; P < 0.001). A higher percentage of the eyes had a postoperative spherical equivalent within ±0.5 D (26.7% pre vs. 52.5% post; P < 0.001) and ±1.0 D (55.0% pre vs. 90.0% post; P < 0.001) of the intended target. A higher proportion of the eyes achieved ≥6/18 uncorrected visual acuity (77.5% pre vs. 91.7% post, P = 0.004), while the proportion with ≥6/18 corrected visual acuity was similar (94.4% pre vs. 98.3% post; P = 0.28). CONCLUSIONS: A structured biometry training course may improve the accuracy of preoperative IOL calculations to achieve the postoperative refractive target. Ophthalmology training programs should include structured biometry teaching in their curricula.
IntroductionThe purpose of this study was to determine the prevalence of diabetic retinopathy in Samoa by piloting a retinal photography screening programme.MethodsWe performed a cross-sectional study of patients with diabetes who presented to the Tupua Tamasese Meaole eye clinic in Apia, Samoa, between May 2011 and September 2011. Study approval was granted by the National Health Service Board of Samoa, the Monash University Human Research Ethics Committee, and the study adhered to the Tenets of the Declaration of Helsinki. Following informed consent, data collection included patient demographics [age, area of residence (rural or urban)], type of diabetes, length of time since diagnosis, most recent random blood sugar and blood pressure levels. The subjects had three 45-degree retinal photographs taken in each eye with the Canon CR6-45NM camera. All gradable photographs were assessed for the presence of diabetic retinopathy or macular oedema using the International Clinical Diabetic Retinopathy Severity Scale and the International Clinical Diabetic Macular Oedema Severity scale, respectively.ResultsTwo hundred and fourteen eyes from 107 subjects were examined during the study period, all of whom had type 2 diabetes mellitus. Diabetic retinopathy was present in 53.3% (114/214) of eyes, with 14.5% having proliferative retinopathy and 7.5% with severe non-proliferative retinopathy. Also, 25.2% (54/214) had some evidence of macular oedema with 11.7% (25/214) requiring treatment. A statistically significant relationship existed between the length of time since diagnosis and the severity of both retinopathy (p < 0.001) and macular oedema (p = 0.031). Blood pressure more than 150/85 mmHg was associated with higher levels of diabetic retinopathy (p = 0.03) and macular oedema (p = 0.02).ConclusionA comprehensive diabetic retinopathy screening programme is much needed in Samoa given the high prevalence of diabetic eye disease.
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