PubMed Health⌕ Search

Biomedical subjects

R A Harrad

Publications and source records attributed to R A Harrad.

At least 19 recordsLinked to original sources
PubMed2006

The psychosocial benefits of corrective surgery for adults with strabismus.

BACKGROUND: Few papers have addressed the psychological impact of strabismus in adults, with none comparing preoperative and postoperative data using standardised questionnaires relating surgical results and psychosocial outcomes. METHODS: 46 participants were seen at their 6 week preoperative and 3 month postoperative appointments. Standardised measures of anxiety and depression (Hospital Anxiety and Depression Scale), social anxiety (Derriford Appearance Scale), and quality of life (WHOQoLBref) were completed. RESULTS: Preoperatively, levels of depression were comparable to relevant population norms; however, levels of general anxiety were slightly raised and levels of social anxiety and social avoidance were significantly poorer than population norms. Surgery resulted in significant improvements in psychosocial adjustment with improvements on all study variables for the participant group as a whole. The non-diplopic group made more significant gains than the diplopic group. Approximately one third of study measures were significantly correlated with the objective measure of eye misalignment preoperatively dropping to only one variable postoperatively. Calculations involving the subjective measure of eye misalignment and study variables showed the opposite pattern with five variables achieving significance postoperatively. There were no clear sex or age effects apparent in the data. CONCLUSION: Strabismus surgery offers significant improvements to psychological and physical functioning.

Adolescent↗
PubMed2004

Small margin excision of periocular basal cell carcinoma: 5 year results.

BACKGROUND: The traditional surgical management of nodular adnexal basal cell carcinomas (BCC) involves excision with 3-4 mm margins and primary repair. This may remove a significant area of healthy tissue, often necessitating a complicated reconstruction, without the confirmation that tumour excision is complete. METHODS: Nodular adnexal BCCs were excised with 2 mm margins, and the repair delayed for 2 days, providing time for histological confirmation of complete excision with formal paraffin sections. Any incompletely excised tumours underwent further resection, which was facilitated by the undisturbed wound edges. Repair was again delayed until further histological examination had confirmed complete excision. RESULTS: 5 year follow up data were available for 55 patients who had undergone small margin BCC excision with delayed repair. 10 patients required more than one excision to achieve clear margins. There were no recurrences. CONCLUSION: Small margin excision of nodular adnexal BCCs with delayed repair is a safe and efficient method. Delayed repair allows histological confirmation of complete excision and assists further resection if required. Preservation of healthy tissue is maximised allowing less radical reconstructive surgery without resorting to Mohs' labour intensive technique.

Adult↗
PubMed2003

Amblyopia treatment outcomes after preschool screening v school entry screening: observational data from a prospective cohort study.

BACKGROUND/AIMS: Preschool screening for amblyopia has controversially been abandoned in some localities within the United Kingdom, on the basis that there is no clear evidence of benefit to support its continuation. Data collected within a birth cohort study were used to examine visual outcomes at 7(1/2) years in children who did or did not receive preschool vision screening. METHODS: Monocular logMAR visual acuity with and without a pinhole was assessed by orthoptists. Contemporary records were used to identify children who had been offered and/or received preschool screening. RESULTS: Of 6081 children, 24.9% had been offered preschool screening and 16.7% had attended. The prevalence of amblyopia was approximately 45% lower in the children who received preschool screening than in those who did not (1.1% v 2.0%, p = 0.05). The mean acuity in the worse seeing eyes after patching treatment was better for amblyopic children who received preschool screening than for those who did not; 0.14 v 0.20 logMAR (p <0.001). These effects did not persist in an intention to screen analysis. CONCLUSIONS: Preschool screening at 37 months was associated with an improved treatment outcome for individuals with amblyopia. However, the improvement was clinically small and disappeared when considering all children offered screening rather than only those who received it. Further research is needed into improving the effectiveness of vision screening for preschool children, while in the interim these data do not conflict with current recommendations for school entry screening by orthoptists.

Age Factors↗
PubMed2002

Amblyopia treatment outcomes after screening before or at age 3 years: follow up from randomised trial.

OBJECTIVE: To assess the effectiveness of early treatment for amblyopia in children. DESIGN: Follow up of outcomes of treatment for amblyopia in a randomised controlled trial comparing intensive orthoptic screening at 8, 12, 18, 25, 31, and 37 months (intensive group) with orthoptic screening at 37 months only (control group). SETTING: Avon, southwest England. PARTICIPANTS: 3490 children who were part of a birth cohort study. MAIN OUTCOME MEASURES: Prevalence of amblyopia and visual acuity of the worse seeing eye at 7.5 years of age. RESULTS: Amblyopia at 7.5 years was less prevalent in the intensive group than in the control group (0.6% v 1.8%; P=0.02). Mean visual acuities in the worse seeing eye were better for children who had been treated for amblyopia in the intensive group than for similar children in the control group (0.15 v 0.26 LogMAR units; P<0.001). A higher proportion of the children who were treated for amblyopia had been seen in a hospital eye clinic before 3 years of age in the intensive group than in the control group (48% v 13%; P=0.0002). CONCLUSIONS: The intensive screening protocol was associated with better acuity in the amblyopic eye and a lower prevalence of amblyopia at 7.5 years of age, in comparison with screening at 37 months only. These data support the hypothesis that early treatment for amblyopia leads to a better outcome than later treatment and may act as a stimulus for research into feasible screening programmes.

Age Factors↗
PubMed2001

Screening for amblyopia in preschool children: results of a population-based, randomised controlled trial. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

INTRODUCTION: The rationale for preschool vision screening programmes has recently been questioned. Evidence about the effects of early treatment is needed, but it is not known how early the target conditions can reliably be detected. In this study, an intensive programme comprising several different screening methods, used at different ages up to 37 months, was compared with the usual practice of visual surveillance and ad hoc referrals. METHODS: Two groups were randomly selected from children in a population birth cohort study. The control group (n = 1461) received visual surveillance only. The intervention group (n = 2029) was offered in addition a programme of regular visual assessments by orthoptists testing visual acuity, ocular alignment, stereopsis and non-cycloplegic photorefraction. RESULTS: The intervention group programme yielded more children with amblyopia (1.6% vs. 0.5%, p < 0.01), and was more specific (95% vs. 92%, p < 0.01), than the control programme. The individual components of the intervention programme were compared. The cover test and visual acuity tests were poorly sensitive until the children were 37 months, but were always >99% specific. Photorefraction was more sensitive than acuity testing at all ages below 37 months, with specificity >95% at 31 and 37 months. CONCLUSIONS: Photorefraction would have detected more children less than 37 months of age with straight-eyed amblyopia than did visual acuity testing, but with more false positives. At 37 months, photorefraction plus a cover test would have been comparable in effectiveness to visual acuity testing plus a cover test.

Amblyopia↗
PubMed2000

Changes in cortical activity during suppression in stereoblindness.

Patients with strabismus or anisometropic amblyopia fixate and attend with one eye and suppress the image from the other eye. Here we use a visual evoked potential technique to show that patients who lack normal stereopsis retain suppressive binocular interactions but lack a characteristic form of non-linear binocular interaction that is present in normal observers. Oscillating grating targets presented at different temporal frequencies in the two eyes evoke a strong response in normal observers at a frequency equal to the sum of the two input frequencies for fusable targets but not for rivalrous ones. However increasing contrast in one eye reduces the response amplitude from the other eye under either fusable (dichoptic masking) or rivalrous conditions. Stereo-deficient observers lack the sum-frequency response, but retain dichoptic masking interactions. Dichoptic masking is stronger when the masker is presented to the patients' dominant rather than non-dominant eyes, suggesting that a subset of preserved binocular inhibitory interactions form the basis of clinical suppression.

Blindness↗
PubMed2000

Superior rectus-levator synkinesis: a previously unrecognized cause of failure of ptosis surgery.

PURPOSE: To describe a previously unreported type of ptosis associated with abnormal synkinesis between the superior rectus muscle and the levator palpebrae superioris. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Seven cases with congenital or longstanding unilateral ptosis presenting to a regional, tertiary referral, oculoplastic service. Six of these cases were seen within a period of 2 years. METHODS: Detailed observations of eyelid, ocular, and pupil movements of both eyes were performed before the planning of ptosis surgery anterior levator resection. MAIN OUTCOME MEASURES: Magnitude of ptosis and its variation with the position of gaze. RESULTS: Ptosis present in the primary position disappeared or markedly reduced with upgaze so that measurements of levator function were apparently normal. Close examination of the relative movement of the eyelids revealed evidence of superior rectus to levator synkinesis occurring during upgaze. In three cases the synkinesis was recognized only after failed ptosis surgery. Once recognized, two of these cases underwent further surgery with an excellent result. Three other patients all had successful surgery. CONCLUSIONS: Superior rectus to levator synkinesis may be easily overlooked if eyelid elevation in upgaze is ascribed to normal levator function rather than a synkinetic movement. We draw attention to the importance of identifying this relatively common condition to plan appropriate ptosis surgery. The lack of levator muscle tone in the primary position of gaze means that an augmented resection of the levator muscle should be performed.

Adolescent↗
PubMed1998

Randomised trial of effectiveness of second eye cataract surgery.

BACKGROUND: The effectiveness of cataract surgery on one eye is well established, but concerns over health-care expenditure have called into question the value of cataract surgery on the second eye. We examined the effects of second eye surgery in terms of patient perceptions as well as through visual acuity, contrast sensitivity, and stereoacuity tests. METHODS: 208 otherwise healthy patients awaiting second eye cataract surgery were recruited into our randomised trial. At randomisation participants were allocated expedited surgery (planned to take place within 6 weeks) or routine surgery (routine waiting time, 7-12 months). Assessments were made at randomisation and again at review after about 6 months. Eight primary trial outcomes consisted of four questionnaire items and four visual function tests, done with both eyes open. FINDINGS: Traditional clinical tests of success in cataract surgery (visual acuity and contrast sensitivity) showed only slight differences in binocular vision in favour of the expedited-surgery group. There were major benefits for the expedited-surgery group in terms of reported visual symptoms and effects on quality of life. At review, differences in self-reported vision related difficulties between the two groups ranged from 11% (95% CI 4.4-17%, activities) to 30% (19-41%, reading). Stereoacuity was better in the expedited surgery group, the difference between the groups for the proportions with stereoacuity of 3000 s of arc or worse was 58% (47-69%). INTERPRETATION: This trial has shown that there is a clear benefit from second eye cataract surgery.

Adult↗
PubMed1998

The management of solitary trichoepithelioma versus basal cell carcinoma.

Currently, all lesions diagnosed clinically as basal cell carcinoma (BCC) are treated by the excision of the lesion with 3-4 mm margins followed by histopathological examination to assess clearance and confirm the diagnosis. We present the findings of surgical incisional and excisional biopsy of three young patients diagnosed on clinical examination as having BCC, who were found on histological examination to have trichoepithelioma. Whilst it may be possible to distinguish the features of trichoepithelioma in incisional biopsy specimens on morphological grounds alone it is often difficult, and immunohistochemical staining, to delineate the features of the basement membrane, provides useful additional information in the histological diagnosis. As trichoepithelioma is more common in the young it should be considered in the differential diagnosis in young patients presenting with BCC-like lesions of the periocular tissues. This subgroup of patients should have incisional biopsy carried out, and if the diagnosis of trichoepithelioma is confirmed the lesion may be excised with a small margin of healthy tissue, thereby facilitating surgical repair.

Adult↗
PubMed1998

Flashing lights in thyroid eye disease: a new symptom described and (possibly) explained.

BACKGROUND/AIMS: Some patients with restrictive thyroid ophthalmopathy, referred for consideration of extraocular muscle surgery, complained of flashing lights in the superior visual field on upgaze. The frequency was assessed and the pathogenesis of this previously unreported symptom explored. METHODS: 30 patients were recruited, all of whom had tight inferior recti and were in the burnt out phase of thyroid eye disease. They were directly questioned regarding any symptoms of photopsia and their records were examined with respect to disease status and treatment, ocular motility, intraocular pressure, retinal status, and surgical intervention. Magnetic resonance imaging (MRI) and cine MRI scans were reviewed for evidence of globe compression. The frequency of symptoms was compared with an age and sex matched control group. RESULTS: Three patients spontaneously complained of flashing lights. A further nine patients had this symptom when directly questioned. 18 patients had no symptoms. None of the 33 control patients had symptoms on direct questioning. Sagittal MRI and cine MRI failed to demonstrate globe compression by the inferior rectus muscle even in cases that showed an intraocular pressure rise in upgaze. CONCLUSION: A new symptom of flashing lights in upgaze has been identified in thyroid eye disease patients with tight inferior recti. It is suggested that the lights are likely to be phosphenes as a result of either compression of the globe by a tight inferior rectus or traction on the insertion of the inferior rectus. The small amount of globe compression required to produce phosphenes seems to be beyond the resolution limit of MRI.

Adult↗
PubMed1998

Do patients with age related maculopathy and cataract benefit from cataract surgery?

AIMS: To assess the benefits of cataract extraction in patients with age related maculopathy (ARM). METHODS: 1073 randomly selected cataract operations were reviewed and 99 cases of preoperatively recognised ARM were identified for investigation. Data relating to visual function were retrieved from case notes, and patient responses to a questionnaire were analysed. RESULTS: 98% had dry or unspecified ARM. Only 2% had exudative maculopathy. 81% of cases had an improvement in best distance acuity; mean change 0.44 logMAR (change of 6/36 to 6/12). 65% responded to the questionnaire; 67% felt that the operation had been worthwhile, 17% had mixed feelings, and 17% thought it not worthwhile. CONCLUSIONS: This study, which is the first of its kind to be reported, shows a clear benefit from cataract surgery in the majority of patients with ARM. However, the prevalence of ARM in this study is lower than expected, suggesting that some patients with both ARM and cataract were not listed for surgery. The design of a prospective study to quantify the subjective and objective benefits of cataract surgery in these patients is outlined and predictors of successful outcome identified. This will promote the development of guidelines for the surgical management of this group of patients.

Aged↗
PubMed1997

Botulinum toxin for the temporary treatment of involutional lower lid entropion: a clinical and morphological study.

PURPOSE: A prospective study was designed to evaluate the use of botulinum toxin as a temporary treatment in patients awaiting surgical repair for involutional entropion and to compare its use with lid taping. METHODS: Botulinum toxin was administered to 30 patients with involutional entropion (35 eyelids). These patients had all previously been using lid taping and lubricant ointment as a temporary measure whilst awaiting lid surgery. Patients' symptoms and signs were assessed before and after toxin injection. The date of entropion recurrence was recorded. Eyelid tissue from 8 patients treated with toxin and 3 control patients who had not been given toxin was obtained after surgical entropion repair and examined histologically to ensure the botulinum toxin had no potential detrimental effects on the results of surgery. RESULTS: The toxin was simple and quick to administer. Anatomical success was achieved in 33 of the 35 eyelids with significant improvements in symptoms and signs. The mean duration of action of the toxin was 12.5 weeks. Lower lid laxity was inversely correlated with duration of toxin action. There were no consistent changes in orbicularis oculi morphology after toxin injection. CONCLUSION: Botulinum toxin is a highly effective temporary treatment for involutional entropion with few complications and no adverse effects on the results of surgical entropion repair.

Bandages↗
PubMed1997

Combined radiotherapy and medical immunosuppression in the management of thyroid eye disease.

Although systemic steroids or orbital radiotherapy are effective in limiting the inflammatory response in thyroid eye disease (TED), there are reports of over 70% of treated patients requiring subsequent rehabilitative surgery: either orbital decompression or strabismus correction. This study investigated whether combined immunosuppression with primary orbital radiotherapy together with azathioprine and low-dose prednisolone, applied early in the active disease state, was more effective in treating TED. Forty consecutive patients with active TED were recruited. Orbital MRI (STIR sequence) was used to assess disease activity. Median duration of symptoms was 1.0 year. Subjects were treated with bilateral orbital radiotherapy (20 Gy in 10 fractions) and oral prednisolone and azathioprine. Pre- and post-treatment activity was measured clinically, including uniocular field of fixation, Mourits score and total eye score, until TED became inactive off all treatment. Before treatment, 15 subjects had signs of dysthyroid optic neuropathy, 35 had significant motility restriction and 38 had marked soft tissue signs. On average TED became inactive after 1.2 years (SD 0.7) of immunosuppression, and treatment was well tolerated. One patient required subsequent cosmetic orbital decompression, 6 had successful strabismus surgery and 13 required minor cosmetic lid surgery. Compared with previously reported treatment regimes we think that combined orbital radiotherapy and medical immunosuppression is far more effective than either treatment alone in the management of active TED, and led to fewer side effects of high-dose steroids. In particular there was more than a four-fold reduction in the requirement for orbital decompression and strabismus surgery.

Adult↗