Summary Background We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. Funding The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. Translations For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.
Significant and sustained IOP increases occur during sTBURG. Preoperative brimonidine does not prevent IOP spikes in sTBURG.
OCT is very helpful in identifying the cause of limited visual recovery after successful retinal detachment (RD) surgery.
Purpose: To describe the demographic characteristics of Glaucoma Suspects (GS) presenting to the glaucoma clinic in a tertiary care settings. Study Design: Descriptive observational study. Place & Duration of Study: Glaucoma clinic of Al-Shifa Trust Eye Hospital, Rawalpindi, from September 2015 to February 2016. Methods: Patients attending the glaucoma clinic were examined and intraocular pressure (IOP), iridocorneal angles, anterior and posterior segments evaluation, vertical cup-to-disc ratio (vCDR) were measured. Retinal nerve fiber (RNFL-Global) thickness was calculated by the Optical Coherence tomography machine using software version 6.0.9. Subjects qualifying as glaucoma suspects were interviewed for demographic and systemic conditions. All the information was recorded on a predesigned proforma and descriptive statistics was used for analysis. Results: A total of 876 patients were examined. Eighty-two (9.36%) patients fulfilled the criteria of GS. There were 57.3% females and mean age of sample was 56.78 ± 12.83 (Range 40 – 70 years). Hypertension was found in 34.1% (n = 28) and diabetes in 25.6% (n = 21). Other diseases were asthma, depression, cardiac and gastric problems. Most of the patients belonged to lower or upper lower class, which represents a huge number on socioeconomic status scale. Mean IOP (both eyes) was 13.93 ± 3.23 mmHg (range 6 – 22 mmHg). Only 5% of subjects had vCDR of > 0.8.RNFL-Global of 79 (48.2%) eyes were within normal limits. Conclusions: Majority of GS belong to lower or lower middle socioeconomic class. The health authorities must focus on this issue to provide easily accessible diagnostic facilities for reducing the economic burden of this problem.
Topical timolol eyedrops are frequently used as medical treatment of glaucoma. They decrease the production of aqueous humor by blocking the beta adrenergic receptors of ciliary body. Although systemic absorption of eyedrops is negligible, still it can cause some serious side effects like bradycardia, heart block, bronchospasm, confusion and hypotension. We present a case who developed nightmares with use of topical beta-blockers. He was a chronic case of primary open angle glaucoma whose target intraocular pressure (IOP) couldn't be achieved with latanoprost alone, the first line drug, so we put him on topical timolol twice daily dosage to further decrease the IOP. On his follow-up visit he complained about bad dreams since starting timolol eye drops. This case report will add to the list of already known other side effects of timolol usage in glaucoma patients.
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