-
Complementary Therapies in Medicine Dec 2022To evaluate the safety and efficacy of acupuncture in the treatment of oculomotor nerve palsy (ONP). (Meta-Analysis)
Meta-Analysis
BACKGROUND
To evaluate the safety and efficacy of acupuncture in the treatment of oculomotor nerve palsy (ONP).
METHODS
The following database will be required from PubMed, Cochrane Library, Medline, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang data. Randomized controlled trials (RCTs) comparing acupuncture alone versus no treatment/another active therapy/sham acupuncture or comparing acupuncture with another active therapy versus the same active therapy were included. Meta-analysis was conducted according to the 2020 PRISMA guidelines. Data was analyzed using RevMan 5.4 software. Results were reported as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). The Cochrane risk of bias tool was used to access the methodological quality of the trails.
RESULTS
Eighteen RCTs with 1150 participants comparing acupuncture versus other therapies were included. The results showed a significant differences in the clinical efficiency rate (RR = 1.30, 95 %CI = 1.23-1.37, P < 0.001), scores of diplopia (MD = - 0.78, 95 %CI = - 1.39 to - 0.77, P < 0.001), palpebral fissure size (MD = 1.04, 95 %CI = 0.41-1.68, P = 0.001), the pupil diameter (MD = - 0.56, 95 %CI = - 0.70 to - 0.42, P < 0.001), quality of life (MD = 8.96, 95 %CI = 6.79-11.13, P < 0.001) between the experiment and control groups. However, there were no significant differences in the adverse effects (RR = 0.52, 95 %CI = 0.22-1.22, P = 0.13). The quality of the evidence test by GRADE was low or very low.
CONCLUSION
Most included studies suggested that acupuncture was more effective than the control group in the treatment of ONP. However, the quality evidence of most of the studies was low and most of them were performed in China.
Topics: Humans; Acupuncture Therapy; Quality of Life; Oculomotor Nerve Diseases; China
PubMed: 36152935
DOI: 10.1016/j.ctim.2022.102888 -
Scientific Reports May 2018Congenital ptosis may be associated with abnormalities of visual development and function, including amblyopia, strabismus and refractive errors. However, the prevalence... (Meta-Analysis)
Meta-Analysis
Congenital ptosis may be associated with abnormalities of visual development and function, including amblyopia, strabismus and refractive errors. However, the prevalence estimates of these abnormalities vary widely. We performed a systematic review and meta-analysis to estimate the prevalence of amblyopia, strabismus and refractive errors in congenital ptosis. Cochrane, Pubmed, Medline, Embase, and Web of Science were searched by July 2017. We used random/fixed effects models based on a proportion approach to estimate the prevalence. Heterogeneity would be considered signifcant if the p values less than 0.1 and/or I greater than 50%. Subgroup analyses, meta-regression analyses and sensitivity analyses were utilized to explore the potential sources of it. A total of 24 studies selected from 3,633 references were included. The highest prevalence was revealed for myopia with 30.2% (95%CI 3.0-69.8%), followed by 22.7% (95%CI 18.5-27.8%) for amblyopia, 22.2% (95%CI 7.8-63.1%) for astigmatism, 19.6% (95%CI 16.5-23.2%) for strabismus, 17.3% (95% CI 13.1-22.9%) for anisometropia and 4.0% for hyperopia (95%CI 1.8-7.1%). Significant heterogeneity was identified across most estimates. Our findings suggest that amblyopia, strabismus and refractive errors in congenital ptosis are present in much higher percentage. This study highlights the importance of early diagnosis and timely treatment of patients with congenital ptosis.
Topics: Amblyopia; Anisometropia; Astigmatism; Blepharoptosis; Humans; Hyperopia; Myopia; Prevalence; Refractive Errors; Strabismus; Visual Acuity
PubMed: 29844360
DOI: 10.1038/s41598-018-26671-3 -
Parkinsonism & Related Disorders Sep 2023The human immunodeficiency virus (HIV) causes movement disorders in persons living with HIV (PLH). (Review)
Review
BACKGROUND
The human immunodeficiency virus (HIV) causes movement disorders in persons living with HIV (PLH).
OBJECTIVES AND METHODS
We conducted a systematic review on the spectrum of movement disorders in PLH using standard terms for each of the phenomenologies and HIV.
RESULTS
Movement disorders in PLH were commonly attributed to opportunistic infections (OI), dopamine receptor blockade reactions, HIV-associated dementia (HAD), presented during seroconversion, developed due to drug reactions or antiretroviral therapy (ART) itself and lastly, movement disorders occurred as a consequence of the HIV-virus. Parkinsonism in ART naïve PLH was associated with shorter survival, however when Parkinsonism presented in PLH on ART, the syndrome was indistinguishable from Idiopathic Parkinson's disease and responded to therapy. Tremor was often postural due to HAD, drugs or OI. Generalized chorea was most frequent in HIV encephalopathy and toxoplasmosis gondii caused most cases of hemichorea. Ataxia was strongly associated with JCV infection, ART efavirenz toxicity or due to HIV itself. Dystonia was reported in HAD, secondary to drugs and atypical facial dystonias. Both cortical/subcortical and segmental/spinal origin myoclonus were noted mainly associated with HAD. In patients with HIV related opsoclonus-myoclonus-ataxia-syndrome, seroconversion illness was the commonest cause of followed by IRIS and CSF HIV viral escape phenomenon.
CONCLUSIONS
Aetiology of movement disorders in PLH depend on the treatment state. Untreated, PLH are prone to develop OI and HAD and movement disorders. However, as the number of PLH on ART increase and survive longer, the frequency of ART and non-AIDS related complications are likely to increase.
Topics: Humans; HIV; Myoclonus; Movement Disorders; HIV Infections; Parkinson Disease; Parkinsonian Disorders; Ataxia
PubMed: 37532621
DOI: 10.1016/j.parkreldis.2023.105774 -
Journal of Neurology Sep 2019Pain is common in atypical parkinsonism such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD) and dementia with... (Meta-Analysis)
Meta-Analysis
Pain is common in atypical parkinsonism such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD) and dementia with Lewy bodies (LBD). In this study, a systematic review and meta-analysis was conducted and peer-reviewed literature was searched to determine the prevalence and types of pain in four atypical parkinsonism syndromes: MSA, PSP, CBD and LBD. The results show that pain was prevalent mainly in MSA patients in comparison to PSP and CBD patients. Pain was reported at an early stage and was found in females, with limb pain being the most common, followed by neck and back pain. In comparison to PSP, pain locations were similar to MSA patients. CBD patients experienced pain the least in comparison to MSA, PSP and LBD patients.
Topics: Cross-Sectional Studies; Humans; Multiple System Atrophy; Pain; Pain Management; Parkinson Disease; Parkinsonian Disorders; Prevalence; Supranuclear Palsy, Progressive
PubMed: 30238268
DOI: 10.1007/s00415-018-9049-7 -
Canadian Journal of Ophthalmology.... Jun 2021Homelessness is a global issue in developing and developed countries. This article is the first systematic review to explore its impact on visual health globally.
BACKGROUND
Homelessness is a global issue in developing and developed countries. This article is the first systematic review to explore its impact on visual health globally.
METHODS
A systematic literature search was conducted on OVID MEDLINE, EMBASE, and Cochrane CENTRAL. Peer-reviewed English-language studies with a focus on homeless children or adults that reported on ocular outcomes were included. Primary outcomes and secondary endpoints were reported via weighted averages. Primary outcomes between homeless children and homeless adults were compared using the Fisher exact test.
RESULTS
There were 5774 individuals across 23 full-text articles included in the review. For studies reporting primary outcomes, 36.8% of homeless individuals self-reported dissatisfaction with their vision, 26.8% self-reported a previous ocular pathology, 26.3% had uncorrected refractive error, 25.6% were functionally visually impaired, 9.2% had at least one previous eye surgery or procedure, and 4.0% had nonrefractive visual impairment. Upon screening, 25.1% of homeless individuals had some type of ocular pathology, which included cornea and external eye diseases (13.4%), glaucoma (7.4%), cataracts (6.3%), retinal diseases (5.3%), ocular motility disorders (4.7%), trauma (2.3%), neuro-ophthalmological conditions (1.7%), and oculoplastic conditions (0.7%). Homeless adults had significantly more visual impairment (p < 0.001), uncorrected refractive error (p < 0.001), ocular pathology (p < 0.001), cataracts (p < 0.001), retinal pathology (p < 0.001), and neuro-ophthalmological conditions (p < 0.001) relative to children.
CONCLUSIONS
Visual impairment in homeless individuals is higher than the general population. Uncorrected refractive error is a leading cause of visual impairment in this population. Additionally, homeless adults have significantly more visual impairment and ocular pathology than homeless children. Future studies should also explore if these differences are consistent in developing countries and investigate ways to increase eye care access for homeless individuals.
Topics: Adult; Child; Glaucoma; Homeless Youth; Humans; Prevalence; Refractive Errors; Vision Disorders; Vision, Low
PubMed: 33098759
DOI: 10.1016/j.jcjo.2020.09.023 -
The Cochrane Database of Systematic... Jul 2014Amblyopia is reduced visual acuity in one or both eyes in the absence of any demonstrable abnormality of the visual pathway. It is not immediately resolved by the... (Review)
Review
BACKGROUND
Amblyopia is reduced visual acuity in one or both eyes in the absence of any demonstrable abnormality of the visual pathway. It is not immediately resolved by the correction of refractive error. Strabismus develops in approximately 5% to 8% of the general population. The aim of treatment for amblyopia is to obtain the best possible level of vision in the amblyopic eye. Different treatment options were examined within the review.
OBJECTIVES
By reviewing the available evidence we wanted to establish the most effective treatment for strabismic amblyopia. In particular this review aimed to examine the impact of conventional occlusion therapy for strabismic amblyopia and to analyse the role of partial occlusion and optical penalisation for strabismic amblyopia.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2013, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2014), EMBASE (January 1980 to January 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 30 January 2014.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) for the treatment of strabismic amblyopia including participants of any age.
DATA COLLECTION AND ANALYSIS
Two authors working independently extracted and entered data into Review Manager 5 and then independently checked the data for errors.
MAIN RESULTS
We included three RCTs in this review. The studies reported mean logMAR visual acuity achieved. Mean difference in visual acuity was calculated. When comparing conventional part-time occlusion (with any necessary glasses), PEDIG 2006 reported that this treatment was more beneficial than glasses alone for strabismic amblyopia; the mean difference between groups was -0.18 LogMAR (statistically significant 95% confidence interval (CI) -0.32 to -0.04). Supplementing occlusion therapy with near activities may produce a better visual outcome compared to non-near activities after four weeks of treatment (PEDIG 2005). The results of the pilot study showed mean difference between groups was -0.17 LogMAR (95% CI -0.53 to 0.19). Results from a larger RCT (PEDIG 2008) are now available, showing that supplementing occlusion therapy with near activities may produce a better visual outcome after eight weeks of treatment; the mean difference between groups was -0.02 LogMAR (95% CI -0.10 to 0.06). One further article ia awaiting assessment as in its current format there is insufficient information to include (Alotaibi 2012).
AUTHORS' CONCLUSIONS
Occlusion, whilst wearing necessary refractive correction, appears to be more effective than refractive correction alone in the treatment of strabismic amblyopia. The benefit of combining near activities with occlusion is unproven. No RCTs were found that assessed the role of either partial occlusion or optical penalisation to refractive correction for strabismic amblyopia.
Topics: Amblyopia; Child; Child, Preschool; Eyeglasses; Humans; Randomized Controlled Trials as Topic; Sensory Deprivation; Strabismus; Visual Acuity
PubMed: 25051925
DOI: 10.1002/14651858.CD006461.pub4 -
The Cochrane Database of Systematic... May 2013The clinical management of intermittent exotropia has been discussed extensively in the literature, yet there remains a lack of clarity regarding indications for... (Review)
Review
BACKGROUND
The clinical management of intermittent exotropia has been discussed extensively in the literature, yet there remains a lack of clarity regarding indications for intervention, the most effective form of treatment and whether or not there is an optimal time in the evolution of the disease at which any treatment should be carried out.
OBJECTIVES
The objective of this review was to analyse the effects of various surgical and non-surgical treatments in randomised trials of participants with intermittent exotropia, and to report intervention criteria and determine the significance of factors such as age with respect to outcome.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library, Issue 4, 2012), MEDLINE (January 1966 to May 2012), EMBASE (January 1980 to May 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to May 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 4 May 2012. We are no longer searching the UK Clinical Trials Gateway (UKCTG) for this review. We manually searched the British Orthoptic Journal up to 2002, and the proceedings of the European Strabismological Association (ESA), International Strabismological Association (ISA) and American Academy of Paediatric Ophthalmology and Strabismus meeting (AAPOS) up to 2001. We contacted researchers who are active in the field for information about further published or unpublished studies.
SELECTION CRITERIA
We included randomised controlled trials of any surgical or non-surgical treatment for intermittent exotropia.
DATA COLLECTION AND ANALYSIS
Each review author independently assessed study abstracts identified from the electronic and manual searches. Author analysis was then compared and full papers for appropriate studies were obtained.
MAIN RESULTS
We found one randomised trial that was eligible for inclusion. This trial showed that unilateral surgery was more effective than bilateral surgery for correcting the basic type of intermittent exotropia.
AUTHORS' CONCLUSIONS
The available literature consists mainly of retrospective case reviews, which are difficult to reliably interpret and analyse. The one randomised trial included found unilateral surgery more effective than bilateral surgery for basic intermittent exotropia. However, across all identified studies, measures of severity and thus criteria for intervention are poorly validated, and there appear to be no reliable natural history data. There is therefore a pressing need for improved measures of severity, a better understanding of the natural history and carefully planned clinical trials of treatment to improve the evidence base for the management of this condition.
Topics: Exotropia; Humans; Randomized Controlled Trials as Topic
PubMed: 23728647
DOI: 10.1002/14651858.CD003737.pub3 -
Clinical & Experimental Optometry Jul 2018Many patient-reported outcome measures (PROMs) have been developed and/or used to measure the impact of amblyopia and strabismus on quality of life (QoL). Identifying...
BACKGROUND
Many patient-reported outcome measures (PROMs) have been developed and/or used to measure the impact of amblyopia and strabismus on quality of life (QoL). Identifying the one with superior quality is important for evaluating the effectiveness of novel therapy for amblyopia and for directing improved clinical decision-making in adults considering strabismic surgery. Therefore, the aim of this review is to identify all PROMs previously developed/used to study the impact of amblyopia and/or strabismus on QoL and to appraise the quality and comprehensiveness of content of the disease-specific instruments.
METHODS
A systematic search was carried out in the electronic databases of PubMed, Cochrane, Web of Science and PsycINFO. The quality of content and measurement properties of all the disease-specific instruments were assessed using established quality standards. Further, the content of the instruments were examined for comprehensiveness by categorising each item across the eight ophthalmic QoL domains (activity limitation, concerns, emotional well-being, social well-being, economic, convenience, symptoms and mobility).
RESULTS
Seventy-one PROMs were identified, out of which 32 were amblyopia- and/or strabismus-specific. Out of all the disease-specific instruments, just four have been subjected to modern psychometric tests and only the adult strabismus questionnaire (AS-20) demonstrated good measurement properties. Most of the amblyopia-specific instruments measured the impact of the treatment of amblyopia on children, while most of the strabismus-specific instruments measured concerns related to appearance and treatment outcome in adults. All instruments have gaps in their content and failed to address QoL comprehensively.
CONCLUSION
All the existing amblyopia- and/or strabismus-specific instruments fall short of desired quality and/or comprehensiveness of content. The review identifies the need for developing an instrument with superior quality and discusses potential directions of future research.
Topics: Amblyopia; Databases, Factual; Humans; Patient Reported Outcome Measures; Psychometrics; Quality of Life; Strabismus; Surveys and Questionnaires
PubMed: 28636173
DOI: 10.1111/cxo.12553 -
Seminars in Ophthalmology 2014To perform a systematic review of the complications of strabismus surgery, focusing on incidence and risk factors. (Review)
Review
PURPOSE
To perform a systematic review of the complications of strabismus surgery, focusing on incidence and risk factors.
MATERIAL AND METHODS
A systematic literature search was performed using the Medline and Cochrane databases.
RESULTS
Local complications, such as conjunctival injection and mild scarring, are almost universal but only rarely have long-term clinical significance. There are several important complications that are uncommon but associated with significant long-term sequelae, including slipped muscles, lost muscles, stretched scars, incarcerated muscles, pulled-in-two syndrome, periocular infections, orbital cellulitis, scleral perforations, retinal detachments, endophthalmitis, anterior segment ischemia, and surgical errors.
DISCUSSION
Strabismus surgery is associated with a number of common and serious complications, and it is important for both surgeons and patients to be aware of the risks.
Topics: Humans; Incidence; Intraoperative Complications; Ophthalmologic Surgical Procedures; Postoperative Complications; Risk Factors; Strabismus
PubMed: 25325869
DOI: 10.3109/08820538.2014.959190 -
JAMA Sep 2017Preschool vision screening could allow detection and treatment of vision abnormalities during a critical developmental stage, preserving function and quality of life. (Review)
Review
IMPORTANCE
Preschool vision screening could allow detection and treatment of vision abnormalities during a critical developmental stage, preserving function and quality of life.
OBJECTIVE
To review the evidence on screening for and treatment of amblyopia, its risk factors, and refractive error in children aged 6 months to 5 years to inform the US Preventive Services Task Force.
DATA SOURCES
MEDLINE, Cochrane Library, CINAHL, and trial registries through June 2016; references; and experts, with surveillance of the literature through June 7, 2017.
STUDY SELECTION
English-language randomized clinical trials (RCTs) or prospective cohort studies that evaluated screening, studies evaluating test accuracy, RCTs of treatment vs inactive controls, and cohort studies or case-control studies assessing harms.
DATA EXTRACTION AND SYNTHESIS
Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings. Studies were not quantitatively pooled because of clinical and methodological heterogeneity.
MAIN OUTCOMES AND MEASURES
Visual acuity, amblyopia, school performance, functioning, quality of life, test accuracy, testability, and harms.
RESULTS
Forty studies were included (N = 34 709); 34 evaluated test accuracy. No RCTs compared screening with no screening, and no studies evaluated school performance, function, or quality of life. Studies directly assessing earlier or more intensive screening were limited by high attrition. Positive likelihood ratios were between 5 and 10 for amblyopia risk factors or nonamblyogenic refractive error in most studies of test accuracy and were greater than 10 in most studies evaluating combinations of clinical tests. Inability to cooperate may limit use of some tests in children younger than 3 years. Studies with low prevalence (<10%) of vision abnormalities showed high false-positive rates (usually >75%). Among children with amblyopia risk factors (eg, strabismus or anisometropia), patching improved visual acuity of the amblyopic eye by a mean of less than 1 line on a standard chart after 5 to 12 weeks for children pretreated with glasses (2 RCTs, 240 participants); more children treated with patching than with no patching experienced improvement of at least 2 lines (45% vs 21%; P = .003; 1 RCT, 180 participants). Patching plus glasses improved visual acuity by about 1 line after 1 year (0.11 logMAR [95% CI, 0.05-0.17]) for children not pretreated with glasses (1 RCT, 177 participants). Glasses alone improved visual acuity by less than 1 line after 1 year (0.08 logMAR [95% CI, 0.02-0.15], 1 RCT, 177 participants).
CONCLUSIONS AND RELEVANCE
Studies directly evaluating the effectiveness of screening were limited and do not establish whether vision screening in preschool children is better than no screening. Indirect evidence supports the utility of multiple screening tests for identifying preschool children at higher risk for vision problems and the effectiveness of some treatments for improving visual acuity outcomes.
Topics: Amblyopia; Child, Preschool; Educational Status; False Positive Reactions; Female; Humans; Infant; Male; Mass Screening; Refractive Errors; Risk Assessment; Risk Factors; Strabismus; Vision Screening; Visual Acuity
PubMed: 28873167
DOI: 10.1001/jama.2017.9900