Bilateral acute retinal necrosis syndrome following herpes simplex type 1 encephalitis.
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Encephalitis, Herpes Simplex↗
Biomedical subjects
R J Pandit
Publications and source records attributed to R J Pandit.
Quality assurance in screening for sight-threatening diabetic retinopathy.
AIMS: There is a need for continuous evaluation of screening services for diabetic retinopathy against agreed performance standards. We describe a quality assurance programme implemented in Newcastle in January 1999 and report on outcomes at 18 months. METHODS: Annual retinal screening is performed using combined retinal photography and direct ophthalmoscopy in two streams. Diabetologists perform screening in the Hospital Screening Programme, which serves patients whose diabetes is managed in specialist clinics, and trained retinal screeners perform screening in the District Screening Programme, which serves patients whose diabetes is managed in the community. Reference standard examination of dilated fundoscopy with a slit-lamp and condensing lens was performed by an ophthalmologist at periodic sessions on consecutive patients attending for screening. RESULTS: Six hundred and nine (6.4%) of 9468 patients screened underwent reference standard examination. The sensitivity and specificity of detection of sight-threatening diabetic retinopathy (STDR) was 82.5% and 98%, respectively, for the Hospital Screening Programme; 85.7% and 95.7%, respectively, for the District Screening Programme; and 83.3% and 96.8% for both services combined. One hundred and ten (18.1%) of 609 patients audited were referred to ophthalmology as a result of screening, and this led to 16 patients (2.6%) receiving laser photocoagulation for STDR. Reference standard examination identified a further four patients (0.7%) who required laser photocoagulation. CONCLUSIONS: Preliminary data indicate that satisfactory performance standards are being achieved. The National Service Framework for Diabetes requires that all units institute quality assurance for retinal screening, and we report the practical implementation of this in one district.
Diabetic Retinopathy↗
Effectiveness of testing visual fields by confrontation.
Many tests are used to examine visual fields by confrontation, but such methods have not been thoroughly compared with an accepted reference standard. The choice of test might affect the identification of subtle defects in the visual field. We prospectively compared seven confrontation field tests with full-threshold automated static perimetry among 138 outpatients in an eye clinic. Our primary outcome was detection of a defect in the visual field. With automated perimetry, most field defects were small or shallow. Most confrontation field tests were insensitive in the identification of field loss. The most sensitive method was examination of the central 20 degrees visual field with a small red target (73% [95% CI 63-82]). Assessment of the visual field should thus include such a test.
Adolescent↗
Mydriasis and glaucoma: exploding the myth. A systematic review.
AIMS: To investigate the risk of inducing acute glaucoma following mydriasis. METHODS: Systematic review of published research 1933-1999. RESULTS: The risk of inducing acute glaucoma following mydriasis with tropicamide alone is close to zero, no case being identified. The risk with long-acting or combined agents is between 1 in 3,380 and 1 in 20,000. The presence of chronic glaucoma constitutes no additional risk. CONCLUSIONS: Mydriasis with tropicamide alone is safe even in people with chronic glaucoma. It should be advised in all patients when thorough retinal examination is indicated.
Glaucoma↗