Biomedical subjects

R P Wormald

Publications and source records attributed to R P Wormald.

8 recordsLinked to original sources

PubMed1992

Visual problems in the elderly population and implications for services.

OBJECTIVE: To determine the prevalence of visual disability and common eye disease among elderly people in inner London. DESIGN: Cross sectional random sample survey. SETTING: Inner London health centre. SUBJECTS: Random sample of people aged 65 and over taken from practice's computerised age-sex register. MAIN OUTCOME MEASURES: Presenting binocular Snellen 6 m distance acuity and best monocular 3 m Sonksen-Silver acuity to classify prevalence of blindness by World Health Organisation criteria (less than 3/60 in better eye) and American criteria for legal blindness (better eye equal to 6/60 or less) and of low vision by WHO criteria (best acuity 6/18) and visual impairment by American criteria (less than 6/12 or 20/40 but greater than 6/60 or 20/200 in better eye). Principal cause of visual loss by diagnosis, referral indication by cause to hospital eye service, and proportion of cases known to primary care. RESULTS: 207 of 288 (72%) eligible people were examined. 17 (8%) housebound subjects were examined at home. The prevalence of blindness was 1% by WHO criteria and 3.9% by American criteria. The prevalence of low vision (WHO criteria) was 7.7%. The prevalence of visual impairment (American criteria) was 10.6%. Cataract accounted for 75% of cases of low vision. Only eight out of 16 patients with low vision were known by their general practitioner to have an eye problem. 56 subjects (27%) would probably have benefited from refraction. Comparisons with studies in the United States and Finland suggested higher rates in this sample, mainly due to the prevalence of disabling cataract. CONCLUSION: There seems to be a considerable amount of undetected ocular disease in elderly people in the community.

Aged↗

PubMed1992

Clinical risk factors for failure in glaucoma tube surgery. A comparison of three tube designs.

We studied a cohort of 165 eyes that had undergone tube implant surgery for glaucoma, with a minimum follow-up of 12 months (range, 12 to 72 months). Of the 57 cases (34.5%) in which surgery failed to control intraocular pressure (less than 22 mm Hg), 15 (26%) occurred by 3 months, 36 (63%) by 12 months, and 46 (80%) by 24 months. Cox regression modeling was used to evaluate independent risk factors in the absence of additional therapy. The use of a two-piece (anterior chamber-to-encircling band) tube system was associated with a 2.4 times higher risk of failure (P less than .001) compared with a one-piece system. Neovascular glaucoma was associated with a 2.1 times higher risk of failure (P less than .037) than other types of glaucoma. Late failure of tube implant surgery is common and there is a steady attrition rate over a 2-year follow-up period.

Adult↗

PubMed1992

Stereopsis and ageing.

This study reports the prevalence of defective stereopsis in an elderly population. Of 728 individuals over the age of 65 who attempted a Frisby stereotest, only 27% had full stereopsis and 29% had no stereopsis. In the elderly population defective stereopsis is a common finding in the absence of any other ocular morbidity. The prevalence of defective stereopsis increased with age. This finding was noted as a part of a survey of eye health of elderly people living in an inner city. The finding was not associated with any symptoms. The significance of this finding is discussed.

Aged↗

PubMed1992

Macular disease in an elderly population.

In order to obtain more accurate information concerning the prevalence of macular diseases in an elderly population, a clinical study was undertaken on a sample of 430 members of the general population over the age of 65 years in London. Degenerative age-related macular changes were clinically visible in about 25%, and 2.8% had a lesion causing loss of visual acuity due to macular disease. Age was the only risk factor identified for age-related changes. No correlation was identified with the prevalence of hypertension, smoking, or diabetes mellitus between groups. In addition, symmetry was shown in the number of drusen, as well as their size, density and fluorescence in the central and peripheral areas between the eyes of affected subjects. The prevalence data from this study represent a baseline for the interpretation of hospital-based data and for the planning of health care.

Aged↗

PubMed1991

Preschool vision screening in Cornwall: performance indicators of community orthoptists.

The performance of community orthoptists was retrospectively assessed in a primary preschool screening programme that has been established in Cornwall since 1982. The outcome of screening was compared between random samples of two birth year cohorts corresponding to the second and fourth years of existence of the screening programme (1980, n = 298 and 1982, n = 300). The mean age at screening was significantly later for the second cohort (4.3 years compared with 4.4 years) but otherwise performance indicators improved in the second cohort. Community orthoptists achieved a sensitivity of about 90% and specificity of 99% during the study. It is unlikely that the more commonly used two tier system of health visitors referring to a community orthoptist could achieve this degree of accuracy.

Child, Preschool↗

PubMed1990

The influence of prior therapy on the success of trabeculectomy.

The role of early surgery in the management of primary open angle glaucoma is under debate. To determine whether previous medical therapy influences the outcome of subsequent trabeculectomy, we retrospectively reviewed the results of surgery in two groups of patients. The first group underwent primary trabeculectomy, having had an average of 2 weeks of preoperative medical therapy, and this group was compared with a group of patients who had received at least 1 year of topical glaucoma therapy before undergoing trabeculectomy (the multiple-treatment group). The two groups were similar in terms of a number of variables, including race, age, sex, presenting intraocular pressures, and presenting visual fields, and they differed only in the known duration of their disease. The success rate of trabeculectomy was significantly higher in the primary trabeculectomy group as compared with that in the multiple-treatment group (P less than .001). We discuss the possible reasons for this difference and its implications for the future management of primary open angle glaucoma.

Aged↗

PubMed1990

Glaucoma triple procedures: efficacy of intraocular pressure control and visual outcome.

Sixty-three glaucoma triple surgeries [combined trabeculectomy, extracapsular cataract extraction (ECCE), and posterior-chamber intraocular lens (PC-IOL) implantation] were reviewed. Intraocular pressure (IOP) was controlled satisfactorily in all cases; 25% required additional glaucoma therapy but fewer glaucoma medications. Eighty-six percent achieved 6/12 or better visual acuity. Postoperative IOP and visual acuity results were similar to those achieved by trabeculectomy or ECCE/PC-IOL, respectively. Cumulative years of preoperative glaucoma therapy had an adverse effect on postoperative IOP control.

Aged↗

PubMed1988

Congenital double lacrimal fistula.

A case of congenital double lacrimal fistula is herein reported. Both fistulae were noted at the time of surgery to connect to the common canaliculus. To the best of our knowledge, this is the only case of a double fistula that has been reported.

Child, Preschool↗