-
Journal of Optometry 2014To analyze the diagnostic criteria used in the scientific literature published in the past 25 years for accommodative and nonstrabismic binocular dysfunctions and to... (Review)
Review
PURPOSE
To analyze the diagnostic criteria used in the scientific literature published in the past 25 years for accommodative and nonstrabismic binocular dysfunctions and to explore if the epidemiological analysis of diagnostic validity has been used to propose which clinical criteria should be used for diagnostic purposes.
METHODS
We carried out a systematic review of papers on accommodative and non-strabic binocular disorders published from 1986 to 2012 analysing the MEDLINE, CINAHL, PsycINFO and FRANCIS databases. We admitted original articles about diagnosis of these anomalies in any population. We identified 839 articles and 12 studies were included. The quality of included articles was assessed using the QUADAS-2 tool.
RESULTS
The review shows a wide range of clinical signs and cut-off points between authors. Only 3 studies (regarding accommodative anomalies) assessed diagnostic accuracy of clinical signs. Their results suggest using the accommodative amplitude and monocular accommodative facility for diagnosing accommodative insufficiency and a high positive relative accommodation for accommodative excess. The remaining 9 articles did not analyze diagnostic accuracy, assessing a diagnosis with the criteria the authors considered. We also found differences between studies in the way of considering patients' symptomatology. 3 studies of 12 analyzed, performed a validation of a symptom survey used for convergence insufficiency.
CONCLUSIONS
Scientific literature reveals differences between authors according to diagnostic criteria for accommodative and nonstrabismic binocular dysfunctions. Diagnostic accuracy studies show that there is only certain evidence for accommodative conditions. For binocular anomalies there is only evidence about a validated questionnaire for convergence insufficiency with no data of diagnostic accuracy.
Topics: Accommodation, Ocular; Diagnostic Techniques, Ophthalmological; Humans; Reproducibility of Results; Vision Disorders; Vision, Binocular
PubMed: 24646897
DOI: 10.1016/j.optom.2013.01.004 -
The Cochrane Database of Systematic... Mar 2013Persistent cough is a common clinical problem. Despite thorough investigation and empirical management, a considerable proportion of those people with subacute and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Persistent cough is a common clinical problem. Despite thorough investigation and empirical management, a considerable proportion of those people with subacute and chronic cough have unexplained cough, for which treatment options are limited. While current guidelines recommend inhaled corticosteroids (ICS), the research evidence for this intervention is conflicting.
OBJECTIVES
To assess the effects of ICS for subacute and chronic cough in adults.
SEARCH METHODS
We searched the Cochrane Airways Group Register of Trials, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and ClinicalTrials.gov in December 2012 and conducted handsearches.
SELECTION CRITERIA
Two authors independently assessed all potentially relevant trials. All published and unpublished randomised comparisons of ICS versus placebo in adults with subacute or chronic cough were included. Participants with known chronic respiratory disease and asthma were excluded. Studies of cough-variant asthma and eosinophilic bronchitis were eligible.
DATA COLLECTION AND ANALYSIS
Two authors independently extracted data pertaining to pre-defined outcomes. The primary outcome was the proportion of participants with clinical cure or significant improvement (over 70% reduction in cough severity measure) at follow up (clinical success). The secondary outcomes included proportion of participants with clinical cure or over 50% reduction in cough severity measure at follow up, mean change in cough severity measures, complications of cough, biomarkers of inflammation and adverse effects. We requested additional data from study authors.
MAIN RESULTS
Eight primary studies, including 570 participants, were included. The overall methodological quality of studies was good. Significant clinical heterogeneity resulting from differences in participants and interventions, as well as variation in outcome measures, limited the validity of comparisons between studies for most outcomes. Data for the primary outcome of clinical cure or significant (> 70%) improvement were available for only three studies, which were too heterogeneous to pool. Similarly, heterogeneity in study characteristics limited the validity of meta-analysis for the secondary outcomes of proportion of participants with clinical cure or over 50% reduction in cough severity measure and clinical cure. One parallel group trial of predominantly chronic cough with 'cough-variant asthma' identified a significant treatment effect and contributed to the majority of statistical heterogeneity for these outcomes. While ICS treatment resulted in a mean decrease in cough score of 0.34 standard deviations (SMD -0.34; 95% CI -0.56 to -0.13; 346 participants), the quality of evidence was low. Heterogeneity also prevented meta-analysis for the outcome of mean change in visual analogue scale score. Meta-analysis was not possible for the outcomes of pulmonary function, complications of cough or biomarkers of inflammation due to insufficient data. There was moderate quality evidence that treatment with ICS did not significantly increase the odds of experiencing an adverse event (OR 1.67; 95% CI 0.92 to 3.04).
AUTHORS' CONCLUSIONS
The studies were highly heterogeneous and results were inconsistent. Heterogeneity in study design needs to be addressed in future research in order to test the efficacy of this intervention. International cough guidelines recommend that a trial of ICS should only be considered in patients after thorough evaluation including chest X-ray and consideration of spirometry and other appropriate investigations.
Topics: Acute Disease; Administration, Inhalation; Adrenal Cortex Hormones; Adult; Antitussive Agents; Chronic Disease; Cough; Humans; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 23543575
DOI: 10.1002/14651858.CD009305.pub2 -
Optometry (St. Louis, Mo.) Dec 2009The aim of this study was to analyze the scientific evidence available on the nonsurgical treatment of accommodative and nonstrabismic binocular dysfunctions,... (Comparative Study)
Comparative Study Review
BACKGROUND
The aim of this study was to analyze the scientific evidence available on the nonsurgical treatment of accommodative and nonstrabismic binocular dysfunctions, identifying the types of treatment used and their efficacy.
METHODS
A systematic review of reports published from 1986 to 2007 was completed using several health science databases: FRANCIS, Medline, Cinahl, and PsycINFO. Those papers that analyzed the treatment of accommodative and nonstrabismic binocular anomalies were included.
RESULTS
Of the 565 articles identified, 16 met the inclusion criteria. Only 3 were clinical trials. All analyzed treatment of convergence insufficiency. Results of clinical trials support the conclusion that vision therapy improves symptoms and signs for convergence insufficiency. Further, the evidence indicates that pencil push-up treatment is not as effective as vision therapy and that prism glasses are no more effective than placebo glasses. For the other nonstrabismic binocular conditions and accommodative disorders, there is a lack of published randomized, clinical trials that support the evidence for the efficacy of each treatment.
CONCLUSION
Scientific evidence exists for the efficacy of vision therapy for convergence insufficiency. Insufficient scientific evidence exists on the best therapeutic options for treatment of the other nonstrabismic binocular anomalies and accommodative disorders.
Topics: Accommodation, Ocular; Convergence, Ocular; Humans; Treatment Outcome; Vision Disorders; Vision, Binocular
PubMed: 19932444
DOI: 10.1016/j.optm.2009.06.011