-
Journal of Glaucoma 2008To systematically review current evidence on the cost-effectiveness of screening strategies for open angle glaucoma (OAG). (Meta-Analysis)
Meta-Analysis
PURPOSE
To systematically review current evidence on the cost-effectiveness of screening strategies for open angle glaucoma (OAG).
MATERIALS AND METHODS
Studies that reported both costs and outcomes of alternative screening strategies for OAG were identified by a highly sensitive search of electronic databases (eg, MEDLINE, EMBASE, NHS EED, HTA Database), last search December 2005. Data on costs regarding cases and years of visual impairment prevented, cases of blindness prevented, and cases of OAG detected were extracted. Incremental cost-effectiveness ratios were calculated using data provided in the included studies.
RESULTS
Four studies met the inclusion criteria. The latest of these was published in 1997. The screening tests and treatments reported in these studies are now not considered to be best practice. Furthermore, data were not reported in sufficient detail to reinterpret the results of the studies in terms of a common outcome measure. Finally, these studies suffered from methodologic weaknesses that further limit their usefulness for decision making.
CONCLUSIONS
Currently, there is insufficient economic evidence on which to base recommendations regarding screening for OAG. New technologies, potentially suitable as screening devices, and new treatments are available. Further research, both in terms of economic models and conduct of clinical trials with concurrent economic evaluation, may help inform policy makers regarding cost-effectiveness and acceptability of screening for OAG.
Topics: Cost-Benefit Analysis; Databases, Factual; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Mass Screening; Ophthalmoscopy; Predictive Value of Tests; Tonometry, Ocular; Vision Screening; Visual Field Tests; Visual Fields
PubMed: 18414099
DOI: 10.1097/IJG.0b013e31814b9693 -
Journal of Neurology, Neurosurgery, and... Jun 2007The objective of this review was to evaluate whether systematic visual training leads to (1) a restitution of the visual field (restoration), (2) an increase in the... (Review)
Review
The objective of this review was to evaluate whether systematic visual training leads to (1) a restitution of the visual field (restoration), (2) an increase in the visual search field size or an improvement in scanning strategies (compensation) and (3) a transfer of training-related improvements in activities of daily living such as reading. To retrieve relevant publications, computer-aided searches of databases (Medline, Embase, Cinahl, Cochrane Central Registers of Controlled Trials) and extensive reference tracing and hand searching were performed. Subsequently, all retrieved and blinded studies were scored on methodological quality. 14 studies were included, 2 randomised controlled trials (RCTs) and 12 within-subject repeated-measures designs (RMD). One of the two RCT studies had good quality. The internal validity of the RMD studies varied from poor to good. Five studies reported a significant effect of the vision restoration therapy (VRT), whereas two studies reported no effect using scanning laser ophthalmoscopy or Goldmann perimetry as outcome measure. All authors of the studies on scanning compensatory therapy (SCT) found a significant effect of up to 30 degrees visual search field, a significant increase in reading speed or decrease in reading errors. It is unclear to what extent patients benefit from restoration therapy in relation to a more efficient scanning strategy which enables them to read faster or to avoid obstacles in a better way. No study has given a satisfactory answer. SCT seems to provide a more successful rehabilitation with more simple and user-friendly training techniques. Validated questionnaires provide the most reliable subjective data to assess the transfer of the relevance of training procedures to activities of daily living of the patient. Hence, SCT is recommended until the effect of the VRT is defined.
Topics: Brain Diseases; Humans; Recovery of Function; Vision Disorders; Visual Fields
PubMed: 17135455
DOI: 10.1136/jnnp.2006.103853 -
Ophthalmology Oct 2005To estimate the risk of malignant transformation of a choroidal nevus in the white population. (Review)
Review
PURPOSE
To estimate the risk of malignant transformation of a choroidal nevus in the white population.
DESIGN
Systematic literature review.
METHODS
A literature review was performed to obtain data on the prevalence of choroidal nevi in the white population. Data from studies that used indirect ophthalmoscopy or otherwise corrected data to include the entire fundus were selected. Only studies reporting on the United States population were included. The number of affected individuals was estimated using 2000 U.S. census data. The estimate of annual incident choroidal melanoma cases in the corresponding age- and race-matched population was calculated using the Surveillance, Epidemiology, and End Result database (1973-2000). Average annual age-specific incidence rates for 1973 to 2000 for each of the 5-year age groups (adjusted for the U.S. 2000 population) were calculated and applied to the corresponding census data. The ratio of numbers of affected individuals with choroidal melanoma and choroidal nevi gave the annual rate of malignant transformation of a choroidal nevus.
MAIN OUTCOME MEASURES
Annual rate of malignant transformation of a choroidal nevus in the white population of the U.S.
RESULTS
The prevalence of choroidal nevus in the white U.S. population ranged from 4.6% to 7.9%. It was estimated that, on average, 8864625 individuals in the U.S. had a choroidal nevus. The number of individuals with choroidal melanoma in the corresponding age- and race-matched population ranged from 989 to 1008 (mean, 1002). The annual rate of malignant transformation of a choroidal nevus was estimated to be 1 in 8845.
CONCLUSIONS
If it is assumed that all choroidal melanomas arise from preexisting nevi, then the published data suggest a low rate (1/8845) of malignant transformation of a choroidal nevus in the U.S. white population.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Cell Transformation, Neoplastic; Choroid Neoplasms; Female; Humans; Incidence; Male; Melanoma; Middle Aged; Nevus, Pigmented; Prevalence; Risk Factors; Sex Distribution; United States; White People
PubMed: 16154197
DOI: 10.1016/j.ophtha.2005.06.011 -
BMJ (Clinical Research Ed.) Jul 2005To evaluate the additional value of funduscopy in the routine management of patients with hypertension. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the additional value of funduscopy in the routine management of patients with hypertension.
DESIGN
Systematic review.
PARTICIPANTS
Adults aged 19 or more with hypertensive retinopathy.
DATA SOURCES
Medline, Embase, and the Cochrane Library from 1990.
REVIEW METHODS
Studies were included that assessed hypertensive retinopathy with blinding for blood pressure and cardiovascular risk factors. Studies on observer agreement had to be assessed by two or more observers and expressed as a kappa statistic. Studies on the association between hypertensive retinopathy and hypertensive organ damage were carried out in patients with hypertension. The association between hypertensive retinopathy and cardiovascular risk was carried out in unselected normotensive and hypertensive people without diabetes mellitus.
RESULTS
The assessment of microvascular changes in the retina is limited by large variation between observers. The positive and negative predictive values for the association between hypertensive retinopathy and blood pressure were low (47% to 72% and 32% to 67%, respectively). Associations between retinal microvascular changes and cardiovascular risk were inconsistent, except for retinopathy and stroke. The increased risk of stroke, however, was also present in normotensive people with retinopathy. These studies did not adjust for other indicators of hypertensive organ damage.
CONCLUSION
Evidence is lacking that routine funduscopy is of additional value in the management of hypertensive patients.
Topics: Adult; Aged; Blood Pressure; Cardiovascular Diseases; Diagnostic Tests, Routine; Humans; Hypertension; Microcirculation; Middle Aged; Observer Variation; Ophthalmoscopy; Retinal Diseases; Retinal Vessels; Risk Factors
PubMed: 16002881
DOI: 10.1136/bmj.331.7508.73 -
Diabetic Medicine : a Journal of the... Jul 2000To determine which screening and monitoring tests for diabetic retinopathy are most effective and under what circumstances. (Review)
Review
AIMS
To determine which screening and monitoring tests for diabetic retinopathy are most effective and under what circumstances.
METHODS
A systematic review of the English language literature, published from 1983 to April 1999.
RESULTS
Available studies are generally limited in their ability to answer the important questions on the effectiveness of tests for early detection of diabetic retinopathy. No randomized controlled trials were identified although primary studies exist for two screening tests: ophthalmoscopy, either direct or indirect, and retinal photography, using either mydriasis or non-mydriasis. Retinal photography under mydriasis appears to be the most effective test, with the majority reporting levels of sensitivity in excess of 80%. However effectiveness is compromised when photographs are ungradable. Ophthalmoscopy can also reach acceptable standards of sensitivity and specificity.
CONCLUSION
Based on an assessment of available cohort studies, the most effective strategy for testing is the use of mydriatic retinal photography with the additional use of ophthalmoscopy for cases where photographs are ungradable. This does not exclude the use of ophthalmoscopy alone for opportunistic case finding but there is evidence of considerable variation in effectiveness of this test.
Topics: Diabetic Retinopathy; Humans; Mass Screening; Mydriatics; Ophthalmoscopy; Photography; Reproducibility of Results
PubMed: 10972578
DOI: 10.1046/j.1464-5491.2000.00250.x