The Effect of Socioeconomic Deprivation on Corneal Graft Survival in the United Kingdom

Chua, Paul Y; Azuara‐Blanco, Augusto; Hulme, William; Jones, Mark; Mustafa, Mohammed Sohaib; Kaye, Stephen B.

doi:10.1016/j.ophtha.2013.07.050

Cited by 19 publications

(14 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…IMD data have successfully been used to highlight social deprivation as an independent risk factor for many systemic diseases 5. In terms of eye disease, the IMD has been used to evaluate the impact of deprivation on low vision7 and a significant factor in the prevalence or presentation of a number of specific eye conditions, including severe neovascular age-related macular degeneration,8 glaucoma9 10 and cataract 11…”

Section: Introductionmentioning

confidence: 99%

United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services

Denniston¹,

Lee²,

Lee³

et al. 2018

Br J Ophthalmol

View full text Add to dashboard Cite

AimTo assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service.MethodsThis is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment.Results79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58).ConclusionsThis large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.

show abstract

Section: Introductionmentioning

confidence: 99%

United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services

Denniston¹,

Lee²,

Lee³

et al. 2018

Br J Ophthalmol

View full text Add to dashboard Cite

show abstract

“…In their study population in Hyderabad, India, Dandona et al found that patients of lower socioeconomic status had a 1.28 times higher risk of graft failure compared with patients of higher socioeconomic status [ 10 ]. In a nationwide study using the United Kingdom Transplant Registry, Chua et al found that the risk of graft failure within 5 years post operation of patients classified as hard-pressed was 1.3 times higher than that of patients classified as wealthy achievers [ 20 ]. In this study, we found that compared to patients who completed college or university, the risk of graft failure was 4.7 times higher among patients with less education.…”

Section: Discussionmentioning

confidence: 99%

Corneal transplantation at Tenwek Hospital, Kenya, East Africa: Analysis of outcomes and associated patient socioeconomic characteristics

et al. 2017

View full text Add to dashboard Cite

PurposeTo review the graft survival rate, visual outcomes, and patient demographics of primary penetrating keratoplasty performed at Tenwek Hospital, a mission hospital in rural Kenya.MethodsA retrospective review was performed of the clinical records of patients who underwent primary penetrating keratoplasty for optical purposes from January 2012 to October 2014. The graft survival rates were constructed using the Kaplan-Meier method, and the effect of clinical and socioeconomic characteristics on time to graft failure were examined using Cox regression models.Results118 patients met the inclusion criteria. The most common indication for surgery was keratoconus (66.1%), followed by corneal scar (22.0%). Despite all patients giving a verbal commitment to do so, 40 patients (33.9%) failed to make it to followup one year postoperatively. Graft survival at one year, inclusive of all indications, was 85.8%. Of the different indications, keratoconus had the highest one-year graft survival rate of 89.9%. Compared to the preoperative uncorrected visual acuity, 85.3% achieved an improvement at one year. Compared to patients who had completed college or university, the risk of developing graft failure was 4.7 times higher among patients with less education (P = 0.01).ConclusionsCorneal transplantation at Tenwek Hospital can be performed with a reasonable chance of success at one year, particularly in cases of keratoconus and in patients with higher educational backgrounds. Adherence to followup recommendations proves to be a challenge in this patient population. Additional studies of larger patient populations with longer follow up periods in similar settings may be helpful in informing appropriate patient selection and maximizing successful outcomes of corneal transplantation in low-resource settings.

show abstract

“…A considerable number of patients are not satisfied with the results of corneal transplantation (14) as it has reduced their social emotions and, as a result, their quality of life (17). In addition, the results have demonstrated that improved vision has a direct association with limitations caused by mood disorders and social performance in patients, so that severe socio-economic restrictions have been shown to increase the risk of corneal transplant rejection (18). Examining and understanding the implications of life with a grafted cornea leads to deep insight in this area that can be added to the body of knowledge of nursing, and help nurses in providing services and optimal care of patients.…”

Section: Introductionmentioning

confidence: 99%

Corneal transplantation: A new view of life

Amiri¹,

Ghiyasvandian²,

Navab³

et al. 2017

Electron physician

View full text Add to dashboard Cite

BackgroundThe consequences of a corneal transplant are evaluated and classified by care providers, but understanding and interpretation of the results varies between patients, and creates different views for them and influences their lives in different ways while these influences are largely unknown.AimThis study aimed to explore understanding of new life in patients after corneal transplantation.MethodsThis qualitative study was conducted using a hermeneutic phenomenological approach in Tehran in 2016. Twelve corneal transplant recipients (7 men, 5 women) who were chosen purposefully from penetrating corneal transplant recipients, participated in this study. Semi-structured interviews were used to collect data. The content of the interviews was transcribed and analyzed using Van Manen’s methodology.ResultsData analysis led to the emergence of several main themes, among which “having a new sense” and “fear and hope” were two of the most important themes.ConclusionIt can be inferred from the overall participants’ experiences that corneal transplant has brought about a new look at life for patients. However, transplant-related issues are endless and continuous, and a sense of fear and hope has always surrounded them.

show abstract

The Effect of Socioeconomic Deprivation on Corneal Graft Survival in the United Kingdom

Abstract: Patients classified as hard-pressed had an increased risk of graft failure within 5 years compared with the least deprived patients.

Cited by 19 publications

References 19 publications

United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services

United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services

Corneal transplantation at Tenwek Hospital, Kenya, East Africa: Analysis of outcomes and associated patient socioeconomic characteristics

Corneal transplantation: A new view of life

Contact Info

Product

Resources

About