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A review of evidence to evaluate effectiveness of intervention strategies to address inequalities in eye health care Annex A: Summary reference table Date: December 2011 [Logo of De Montfort University] This annex accompanies the report: A review of evidence to evaluate effectiveness of intervention strategies to address inequalities in eye health care, RNIB report: RNIB/CEP/01, 2011. To accommodate formatting constraints, the font used in this annex may not be fully accessible. A large print version of the annex is available on request. Atri J, Falshaw M, Gregg R, Robson J, et al. (1997). Improving uptake of breast screening in multiethnic populations: a randomised controlled trial using practice reception staff to contact non-attenders. British Medical Journal. Vol. 315, pp. 1356-9. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A controlled trial randomised by general practice to determine whether a two hour training programme for general practice reception staff could improve uptake in patients who had failed to attend for breast screening, and whether women from different ethnic groups benefited equally 2,064 women aged 50-64 years who came from 26 general practices in the inner London borough of Newham, 31% were white, 17% were Indian, 10% Pakistani, 14% black, 6% Bangladeshi, 1% Chinese, 4% were from other ethnic groups, and in 16% the ethnic group was not reported Intervention group: Training programme for a member of reception staff at a general practice. Control group: No training programme for reception staff Attendance for breast screening in relation to ethnic group in women who had not taken up their original invitation Attendance in the intervention group was significantly better than in the control group with the best response coming from Indian women Train front line staff and use telephone calls to remind people called for screening. This intervention could be effective as part of a multifaceted strategy to improve uptake in areas with low rates Strong but indirect as does not focus on vision v1.1 Page 1 of 91 Access Economics (2009) Future sight loss UK (1): The economic impact of partial sight and blindness in the UK adult population. Report prepared for RNIB by Access Economics Pty Limited, July 2009. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Epidemiological estimates of the numbers of people likely to have agerelated macular degeneration (AMD), cataract, diabetic retinopathy (DR) and glaucoma at two points in time, 2010 and 2020 A ‘System Dynamics’ model to simulate the dynamics of eye disorders in large populations n/a Estimates of the numbers of the prevalence of agerelated macular disease, cataract, diabetic retinopathy and glaucoma AMD: in 2010, 223,224 people partially sighted or blind. In 2020, figure is 291,982 Authors observed that a more robust information base is required Fit for purpose. Estimated costs to society of the resources used in health and social service and in providing informal care in that time frame The ‘system’ comprises the given population and the health care and related resources therein The baseline and cumulative costs to society of the prevailing health and social care provision Cataract: number of operations in 2010 more than 389,000. rising to 473,944 in 2020 DR: in 2010, 65,958 people partially sighted or blind. In 2020, figure is 76,430 The serious deficit in reliable information on levels of detection and treatment coverage for eye conditions limits the output of this decade model at present Glaucoma: in 2010, 75,157 people partially sighted or blind. In 2020, figure is 75,157 v1.1 Page 2 of 91 Acharya N, Lois N, Townend J, Zaher S, Gallagher M, Gavin M (2009) Socio-economic deprivation and visual acuity at presentation in Exudative age-related macular degeneration. Br J Ophthalmol, 93: 627-629. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Study to evaluate the influence of socio-economic factors on visual acuity (VA) at presentation in exudative agerelated macular degeneration (AMD) All consecutive patients with newly diagnosed exudative AMD examined at the Ophthalmology Departments of two hospitals in Scotland, between July 2004 and June 2005 (n = 240) n/a Ophthalmic: VA in study and fellow eye, exudative AMD characteristics; and status of fellow eye Age, location and type of the choroidal neovascularisation were statistically significantly associated with VA at presentation Age, location and type of choroidal neovascularisation, but not socioeconomic deprivation, were associated with VA at presentation in exudative AMD Fit for purpose Demographics; duration of symptoms; and patient home address, to determine the Scottish Index of Multiple Deprivation (SIMD) score v1.1 SIMD scores, area and VA in the fellow eye were not associated with presenting vision Page 3 of 91 AREDS (2001) A Randomized, Placebo-Controlled, Clinical Trial of High-Dose Supplementation With Vitamins C and E, Beta Carotene, and Zinc for Age-Related Macular Degeneration and Vision Loss: AREDS Report No. 8’ (Age-Related Eye Disease Study Research Group). Arch Ophthalmol, 119: 1417-1436. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A randomized, placebo-controlled study to evaluate the effect of highdose vitamins C and E, beta carotene, and zinc supplements on AMD progression and visual acuity Participants aged 55 to 80 enrolled into 11 retinal specialty clinics between the years 1992 and 1998 (n = 3640) Participants were randomly assigned to receive daily oral tablets containing: (1) antioxidants (vitamin C, 500 mg; vitamin E, 400 IU; and beta carotene, 15 mg); (2) zinc, 80 mg, as zinc oxide and copper, 2 mg; (3) antioxidants plus zinc; or (4) placebo Photographic assessment of progression to or treatment for advanced AMD Versus placebo, statistically significant odds reduction for the development of advanced AMD with antioxidants plus zinc Persons older than 55 years should have dilated eye examinations to determine their risk of developing advanced AMD Strong Moderate visual acuity loss from baseline (> or =15 letters) Estimates of odds ratios (ORs) for specified outcomes v1.1 Both zinc and antioxidants plus zinc significantly reduced the odds of developing advanced AMD in the higher-risk group Those with extensive intermediate size drusen, at least 1 large druse, or advanced AMD should consider taking a supplement of antioxidants plus zinc Page 4 of 91 Awobem JF, Cassels-Brown A, Buchan JC, Hughes KA (2009) Exploring glaucoma awareness and the utilization of primary eye care services: community perceived barriers among elderly African Caribbeans in Chapeltown, Leeds. Eye, 23(1): 243. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Community-based qualitative study conducted in fulfilment of a Masters in Public Health Dissertation to explore knowledge and attitudes concerning glaucoma and investigate the utilisation and barriers to uptake of primary eye care Members of the Black AfricanCaribbean community living in a large city in Northern England (n = 16) n/a Knowledge and attitudes concerning access to primary eye care services (PECS) Utilisation of PECS was largely symptom driven Initiatives to overcome attitudinal barriers to the uptake of PECS are necessary from the service user and the provider perspective Fair/weak Once attendance is established, optometrist letters a substantial incentive for attendance (50% of respondents) Family members most important source of info about glaucoma (87%) Barriers to PECS include perceived cost of eye tests (37%); mistrust (31%); pressure to buy expensive glasses (37%) v1.1 Page 5 of 91 Baker H, Murdoch IE. (2004). Can a public health package on glaucoma reach its target population? Eye. Vol. 18, pp. 478-82. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A pilot study to assess how successful a newspaper advertisement and a radio interview about glaucoma are at reaching their target population A convenience method of sampling used for residents aged 45+ years living in either Southall, London or on the Isle of Wight An interview on local radio and an advertisement in the local newspaper A questionnaire administered pre and post intervention Participants who had heard of glaucoma increased from 54% before the intervention to 60% after. Those who had heard of the disease increased by 13% in Southall (SA sample) from lower baseline and by 8% on the Isle of White Media work differently for different groups / locations Fit for purpose Participants were approached in the high street and local temples in Southall, London and in the town centre of Newport, Isle of Wight Questionnaire in Hindi for residents of Southall, London and in English for residents of Isle of Wight Statistical analysis of survey data Further research is required to determine the best method of reaching target populations through radio. Other media may need to be considered Newspaper advert was effective in both areas but radio interview only affected residents of Southall, London v1.1 Page 6 of 91 Baker H, Murdoch IE. (2008). Can a public health intervention improve awareness and health-seeking behaviour for glaucoma? British Journal of Ophthalmology. Vol. 92, pt. 12. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality To investigate whether a public education campaign can increase awareness and change helpseeking behaviour with respect to ocular health in an Indian population Indian population aged 60+ years living in Southall, Ealing Health knowledge questionnaire and a health campaign consisting of television advertising, local press, local radio and places of worship Sight test data collected by local optometric patients 6 months before and after the intervention After the intervention the majority of participants (69%) heard about glaucoma from local radio rather than from their GP though the study did not show a change in health seeking behaviours Radio appeared to be the most effective method of reaching target group (Indians aged 60+ years) but had little effect on behaviour Fit for purpose v1.1 UK study Page 7 of 91 Bellary S, O'Hare JP, Raymond NT, Gumber A, et al (2008). Enhanced diabetes care to patients of south Asian ethnic origin (the United Kingdom Asian Diabetes Study): a cluster randomised controlled trial. Lancet. 24;371(9626), pp. 1769-76. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Cluster randomised trial investigating the effectiveness of a culturally sensitive, enhanced care package in UK general practices for improvement of cardiovascular risk factors in patients of south Asian origin with type 2 diabetes 1,486 patients at 21 general practices, seven in Coventry (patients = 500) and 14 in Birmingham (patients = 986). General practices were chosen for the high number of south Asian patients they have (80%+) Intervention group: Enhanced care including additional time with practice nurse and support from a link worker and diabetesspecialist nurse Changes in blood pressure, total cholesterol, and glycaemic control (haemoglobin A1c) after 2 years. A comparison of intervention and control groups after 2 years showed significant differences for diastolic blood pressure and mean arterial pressure after adjustment for confounding and clustering Small but sustained improvements in blood pressure in SA patients can be achieved through a culturally sensitive, enhanced care package. Improvement in glycaemic control remains a major challenge. Further work on healthcare delivery in general practice and to improve motivation is needed to reduce health-care inequalities Strong Statistical analysis Control group: Standard care Nine of the practices received the intervention (n= 868) while 12 were included in the control group (n=618) v1.1 UK study Page 8 of 91 Burr JM, Mowatt G, Hernández R, Siddiqui MAR, Cook J, Lourenco T, Ramsay C, Vale L, Fraser C, AzuaraBlanco A, Deeks J, Cairns J, Wormald R, McPherson S, Rabindranath K, Grant A (2007) The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation Health Technology Assessment 11,41 Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Systematic review to determine if OAC screening meets national criteria for inclusion in NHS national screening programmes All relevant papers in major electronic databases up to 2005 Screening Evidence of benefit (years of added quality life etc) No RCTs found nor any consistent evidence of effectiveness although some support that early treatment is desirable Screening for high risk groups (defined as ‘Black’ ethnic groups and older age groups might be justifiable but at present best practice would be to improve opportunistic case finding through regular attendance at eye health checks Strong (Systematic review with health economics assessments) Insufficient evidence to estimate risks in other ethnic groups (non-African descent) v1.1 UK study Page 9 of 91 Busby D (2004) First Report of the National Eye Care Steering Group London: Department of Health. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality First report of the Eye Care Services Steering Group set up in 2002 to develop proposals for modernisation of NHS eyecare, maintaining and developing an integrated, patientcentred service, and improving access, choice, waiting times and quality Dependent upon original study included in the review n/a n/a Incidence of visual impairment will rise by approx. 35% by 2020 NHS needs to develop primary care ophthalmic services to meet increased need, particularly from demographic change Fit for purpose By age 75, a quarter of all people will have developed a cataract Prevalence of glaucoma rises from 1-2% >40s, to 5% of >75s ARMD is the most common cause of irremediable serious visual lossin people over 65 years of age v1.1 Developing partnerships between primary, secondary care and patient will increase access and choice With training and protocols, primary care could take an enhanced role to benefit of patients and professional development Page 10 of 91 Chou R, Dana T, Bougatos C (2009) Screening older adults for impaired visual acuity: a review of the evidence for the US Preventive Services Task force (Cochrane review). Annals Internal Medicine, 151: 37-43 and 44-58. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Review of randomized trials and controlled observational studies to update the 1996 U.S. Preventive Services Task Force evidence review on benefits and harms of screening for impaired visual acuity in primary care settings in adults age 65 years or older Dependent upon original study included in the review n/a Direct evidence on screening and the accuracy of diagnostic tests Screening for VI in older adults in primary care settings is not associated with improved visual or clinical outcomes More research is needed to understand why direct evidence shows no benefits of screening, even though impaired visual acuity is common and effective treatments are available Strong Participants from studies that directly evaluated screening for impaired visual acuity in older adults from 1996 to July 2008 Benefits and harms of treatment. Quantitative estimates for treatment effects and relative risks using a randomeffects model Effective treatment is available for refractive error, cataracts, and AMD Non-UK study so may not be totally transferable Visual acuity test is standardr screening for vision impairment in primary care, but diagnostic accuracy is uncertain v1.1 Page 11 of 91 Claydon BE, Efron N, Woods C (1998) Non-compliance in optometric practice. Ophthal Physiol Opt, 18(2): 187190. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Review of noncompliance in contact lens behaviour in relation to organisation of optometric practice n/a – mainly selfcitation n/a n/a n/a Optometric profession should pay attention to compliance issues weak v1.1 Page 12 of 91 Coleman HR, Chan CC, Ferris FL 3rd, Chew EY. (2008) Coleman, A. L. (1999) Glaucoma. Lancet 354 (9192), 1803-1810. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Review of the knowledge related to the diagnosis, screening, aetiology and risk factors, and management of glaucoma Dependent upon original study included in the review n/a Dependent upon original study included in the review Various Worldwide prevalence of POAG and PCAG will continue to increase Fit for purpose Dependent upon original study included in the review Glaucoma detection should be more aggressive Burden of POAG and PCAG falls on patients, but also on society Information might highlight need for periodic eye examinations among individuals with family history v1.1 Page 13 of 91 Coleman HR, Chan CC, Ferris FL 3rd, Chew EY. (2008) Age-related macular degeneration. Lancet, 22, 372 (9652): 1835-45. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Review of the literature related to the epidemiology, risk factors, pathophysiology, and management of age-related macular degeneration (AMD) Dependent upon original study included in the review Various Various Various Fit for purpose Mainly dietary supplementation, and vascular endothelial growth factor (VEGF) inhibitors Development of AMD Dependent upon original study included in the review AMD is leading cause of blindness in elderly people of western descent Modifiable risk factors Most common risk factors are age and cigarette smoking Treatment with antioxidant vitamins and zinc can reduce the risk of developing AMD by a quarter in those at least at moderate risk Intravitreal ranibizumab can stabilise vision loss and may improve vision v1.1 Page 14 of 91 Congdon N, Vingerling JR, Klein BE, West S, Friedman DS, Kempen J, O'Colmain B, Wu SY, Taylor HR; Eye Diseases Prevalence Research Group (2004). Prevalence of cataract and pseudophakia/aphakia among adults in the United States. Archives of Ophthalmology, 122(4): 487-94. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality To determine the prevalence of cataract and prior cataract surgery (pseudophakia/ aphakia) in the United States and to project the expected change in these prevalence figures by 2020 Dependent upon original study: Black, white and Hispanic persons with cataract or pseudophakia/ aphakia n/a Estimates of cataract and of pseudophakia/ aphakia, measured in 5-year age intervals starting at 40 years old Pooled age-specific prevalence figures for cataract increased with age for both black and white persons (P< 0.001) The number of Americans affected by cataract and undergoing cataract surgery will dramatically increase over the next 20 years as the US population ages Fair but major problems of heterogeneity Seven studies (n = approx 50,000), Barbados Eye Study; Beaver Dam Eye Study; Blue Mountains Eye Study; Melbourne Vision Impairment Project; Proyecto Vision Evaluation Research; Rotterdam Study, Salisbury Eye Evaluation Covariates: age and race/ethnicity Odds ratios (ORs) calculated for relevant variables Women have a significantly (odds ratio=1.37; 95% confidence interval, 1.26-1.50) higher age-adjusted prevalence of cataract Prevalence of cataract in US did not systematically differ from Australia and Europe v1.1 Non-UK study Existing data are very poor even in majority groups: more and better research and data collection needed Page 15 of 91 Cook PF, Bremer RW, Ayala A, Kahook MY. (2010). Feasibility of motivational interviewing delivered by a glaucoma educator to improve medication adherence. Clinical Ophthalmology. Vol. 4, pp. 1091–1101. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Randomized trial to ascertain whether motivational interviewing (MI) for patients with glaucoma is feasible in a busy ophthalmology practice 51 patients with primary or secondary openangle glaucoma prescribed monotherapy topical glaucoma medication from glaucoma clinic at Rocky Mountain Lions Eye Institute, Denver, CO. (USA) Intervention group (n=8) received standard care with MI while control group (n=4) received standard care MI training and instruction manual for MI educator, documentation of MI training (education evaluation tools, session records) and state of change rating to measure patient enactment after MI Glaucoma educators’ knowledge and delivery of MI improved after training MI training is feasible in a busy ophthalmology practice and can be implemented with a standardised training approach Fit for purpose Statistical analysis using SPSS Patients assigned to the intervention group improved over time in both motivation and adherence to medication 37 participants excluded from the study (less than 80% adherence to treatment) Twelve patients agreed to take part in RCT v1.1 Non-UK study 50% of participants in intervention group completed all MI training sessions Page 16 of 91 Cross V, Cragg R, Shah P (2009) Attitudes to patient partnership in the management of African-Caribbean glaucoma. Final Report for the Guide Dogs for the Blind Association (Project Reference 2006-02b). Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusion Quality Study of attitudes of users and professionals to patients participation and self-care, and implications for African-Caribbean people living with Glaucoma 32 informants (11 patients, 4 nurses, 5 surgeons, 6 optometrists) and use of Q-sort technique To enhance selfmanagement strategies Qualitative sets of typical views, and some health related quality of life estimates Practitioners had low expectations of patient abilities; patients were perhaps overconfident but willing to engage Need for more vocal and effective use of community champions and informal dissemination: young A/C patients are at high risk Fit for purpose v1.1 UK study Page 17 of 91 Cross V, Shah P, Bativala R, Spurgeon P (2005) Glaucoma Awareness and Perceptions of Risk among AfricanCaribbeans in Birmingham UK. Diversity in Health and Social Care, 2(2): 81-90. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusion Quality Qualitative study to explore issues related to glaucoma awareness and perceptions of risk among the AfricanCaribbean population African– Caribbean participants who were not receiving treatment from a hospital eye service (n = 48) n/a Knowledge of glaucoma; glaucoma risk perception and protection motivation; images of blindness; health accounts; cultural context and individual differences Positive attitude to health promotion does not include eye health Study will help practitioners to understand the health beliefs of African–Caribbean patients Fit for purpose Family history helping individuals to understand how glaucoma might affect them UK study Attitudes to blindness reflect notion of blind person as victim Preventative action depends on credibility of both source and nature of information v1.1 Page 18 of 91 Cross V, Shah P, Bativala R, Spurgeon P (2007) ReGAE 2: Primary Eye Care Service Utilisation and Glaucoma: some viewpoints from African-Caribbeans in Birmingham UK. Eye, 21: 912-920. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A qualitative investigation to identify issues related to utilisation of Primary Eye Care Services (PECS) by African-Caribbean people and consider the implications for enhancing the role of the PECS in glaucoma detection and management Face-to-face interviews and focus group discussions with members of the African Caribbean community outside the hospital eyeservice (n = 48) n/a PECS utilisation focused on three key areas: access route to the optometrist, causal stimulus for an optometric visit, and experiential accounts of the optometric encounter Positive attitudes to health promotion existed, but ‘eye health’ was not integral to individuals’ health schemas Enhancing reciprocal understanding between service users and ophthalmic practitioners in primary care is central to developing flexible, responsive local eye-care services Fit for purpose The capacity for primary eye care to enhance glaucoma knowledge appeared under utilised and inconsistent UK study Service delivery undermined by perceived conflicts of interest v1.1 Page 19 of 91 Das BN, Thompson JR, Patel R, Rosenthal AR. (1990) The prevalence of age related cataract in the Asian community in Leicester: a community based study. Eye, 4(5): 723-6. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A community based ophthalmic survey to report on the prevalence of the age-related cataract in an Asian Community in the UK and to investigate possible risk factors associated with the disease Asians and Caucasians (white) aged 40 years and over registered with four inner-city general practitioners in the City of Leicester, England (n = 115 Asians, 119 Caucasians and 6 African Caribbeans) n/a Ophthalmic: presence of age related cataract Prevalence of agerelated cataract significantly higher in Asians when compared to (white) Caucasians This populationbased study indicates that there is a significantly higher prevalence of age-related cataract in the Asians living in Britain Fit for purpose All cataracts that could be ascribed to congenital or secondary causes were excluded Covariates: age; gender; ethnic origin; racial subgroup; history of smoking; alcohol consumption; diet medication & medical history; and episodes of severe diarrhoea v1.1 Age-related cataract was found to develop earlier in the Asians A strict vegetarian diet found to be a significant risk factor for age-related cataract in Asian community in Leicester UK study The findings suggest an earlier onset of the disease in Asians Repeat analysis will be considered when a larger sample size is available Page 20 of 91 Das BN, Thompson JR, Patel R, Rosenthal AR (1994) The prevalence of eye disease in Leicester: a comparison of adults of Asian and European descent. J R Soc Med, 87(4): 219-22. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Ophthalmic survey to report on the prevalence of eye disease among adults of Asian and European descent in the UK People aged 40 years and over registered with two neighbouring inner-city general practices: one predominantly with Asian patients (n = 173) and the other predominantly with European patients (n = 204) n/a Ophthalmic: visual acuity for near and distance; diagnosis of age related cataract, age related macula degeneration, open angle glaucoma and diabetic retinopathy Asians had a significantly higher prevalence of agerelated cataract It is important to both the health services and to scientific research that we continue to monitor eye disease in the British Asian Community to see if the patterns of disease change with time Fit for purpose Covariates: age band; gender; diabetes v1.1 The age of onset of cataract seems earlier in Asians After adjustment for age, no statistically significant ethnic differences in the prevalence of openangle glaucoma, macular degeneration or diabetic retinopathy UK study Page 21 of 91 Day F, Buchan JC, Cassells-Brown A, Fear J, Dixon R, Wood F (2010) A glaucoma equity profile: correlating disease distribution with service provision and uptake in a population in Northern England, UK. Eye, 24(9): 147885. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Equity profile to examine the scale of health inequalities in a population in Northern England, UK The equity profile was conducted in Leeds, a city in the north of England, with a population of 794,777 in April 2008 n/a Location of general ophthalmic services (GOS) and hospital eye Services A mismatch between areas of deprivation and location of optometry Increasing access involves collaboration with optometrists, ophthalmologists, public health, and commissioners Fit for purpose Distribution of glaucoma, known risk factors for glaucoma, and deprivation Electronic patient record (EPR) data; primary care prescribing data; certifications for visual impairment (CVI); hospital episode statistics; GP with special interest audit data; GOS data; and qualitative data on barriers to uptake v1.1 Significant association between ‘late presentation’ and older age Late presentation associated with living in area of high deprivation Ethnicity data was poorly recorded Qualitative data provided invaluable insights UK study Not acceptable to rely on private high street optometry to provide primary eye care services in areas of high need Outreach services must be developed and evaluated in areas of relative deprivation if world class eye services are to be achieved Page 22 of 91 Demakakos P, Nazroo J Y, Breeze E, Marmot M (2008) Socioeconomic status and health: the role of subjective social status. Social Science and Medicine, 67(2): 330-340. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Cross-sectional data from the second wave (2004–2005) of the English Longitudinal Study of Ageing to examine the link between subjective social status (SSS) and health in old age and investigate whether SSS mediated the associations between objective indicators of socioeconomic status and health People included in the second wave (2004–2005) oft the English Longitudinal Study of Ageing who reported their SSS (n = 3368 men; 4065 women) n/a Self-rated health, long-standing illness, depression, hypertension, diabetes, central obesity, high-density lipoprotein cholesterol, triglycerides, fibrinogen, and Creactive protein. Subjective social status In age-adjusted analyses SSS was related positively to almost all health outcomes. Many of relationships remained significant after adjustment for covariates. SSS mediated fully or partially the associations between education, occupational class and self-reported and clinical health measures SSS is an important correlate of health in old age, possibly because of its ability to epitomize life-time achievement and socioeconomic status Fit for purpose Covariates: wealth; education; occupational class; age; gender and marital status v1.1 UK study Page 23 of 91 Desai P. (1993) The National Cataract Surgery Survey: III. Process features. Eye, 7(5): 667–671. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Prospective crosssectional survey to examine the process of how medical care is provided for cataract patients within the National Health Service Patients of 50 years of age and over who had surgery for agerelated cataract in the UK during the period of the 1990 National Cataract Surgery Survey (n = 975) n/a Waiting time and level of visual impairment: on presentation at the first out-patient assessment, on listing for surgery and on admission for surgery The majority of patients have considerable levels of visual impairment by the time they present to the hospital eye service The survey represents the experience of a sample of all patients undergoing surgery for agerelated cataract in the UK in 1990 Fit for purpose Visual acuities; length of stay in hospital, duration of post-operative medication, number of post-op outpatient visits and final refraction Age-standardised operation rates by region v1.1 A difference of almost twofold was observed between the lowest and highest regional operation rates, although it must be interpreted with caution UK study Repeating the survey at regular intervals would provide a practical method of evaluating and auditing surgical practice for national trends in the management of age-related cataract Page 24 of 91 Duke SAS, Colagiuri S, Colagiuri R. Individual patient education for people with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD005268. DOI: 10.1002/14651858.CD005268.pub2. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Systematic review to evaluate the effectiveness of individual patient education on metabolic control, diabetes knowledge and psychosocial outcomes Dependent upon original study included in the review Individual face-toface patient education verses usual care, routine treatment or group education Primary outcomes: metabolic control; diabetes complications; health service utilisation and health care costs Individual face-toface education did not significantly improve glycaemic control compared with usual care Benefit exists of individual education on glycaemic control when compared with usual care in those with a baseline HbA1c greater than 8% Strong Nine randomised controlled or controlled clinical studies (n = 1359 participants) Participants were adults diagnosed with type 2 diabetes over the age of 18 years Six studies compared individual education to usual care and three compared individual education to group education Only studies that assessed outcome measures at least six months from baseline were included Secondary outcomes: psychosocial outcomes; diabetes knowledge; patient self-care behaviours; physical measures and metabolic measures v1.1 Individual education had a significant benefit on glycaemic control in patients with a higher mean baseline HbA1c (greater than 8%) No significant difference in glycaemic control between individual and group education Overall, there did not appear to be a significant difference between individual education and usual care In the small number of studies comparing group and individual education, the impact was equal on HbA1c at 12 to 18 months Page 25 of 91 Eke T, Reddy MA, Karwatowski WS. (1999). Glaucoma awareness and screening uptake in relatives of people with glaucoma. Eye. Vol. 13, pt. 5. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality To assess glaucoma awareness and screening uptake in relatives of people with glaucoma 52 patients with primary open angle glaucoma attending Leicester Royal Infirmary and their relatives (n=90) n/a Questionnaires for patients and their relatives measuring awareness of glaucoma and available screening services 53% of relatives felt they were at increased lifetime risk of developing glaucoma, 81% of relatives had been screened but this was infrequently Relatives of people with glaucoma should be made more aware of the need for glaucoma screening and encouraged to use the free screening service Fit for purpose Analysis of questionnaires returned by relatives of patients (n=70) v1.1 Siblings of patients with glaucoma had lower awareness of screening services than their offspring UK study Older relatives should be particularly targeted Page 26 of 91 Evans J. (2008). ‘Antioxidant supplements to prevent or slow down the progression of AMD: a systematic review and meta-analysis’. Eye. Vol. 22, pt. 6, pp.751-60. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A systematic review examining the evidence as to whether antioxidant vitamin or mineral supplements prevent the development of AgeRelated Macular Degeneration (AMD) or slow down its progression Dependent upon original studies included in review Antioxidant vitamin and/or mineral supplementation (alone or in combination) to control groups Ophthalmic: development and progression of agerelated maculopathy (ARM ), AMD and loss of vision There was no evidence that antioxidant (vitamin E or β-carotene) supplementation prevented AMD Current evidence does not support the use of antioxidant vitamin supplements to prevent AMD Strong Information on adverse events There was evidence that antioxidant (βcarotene, vitamin C, and vitamin E) and zinc supplementation slowed down the progression to advanced AMD and visual acuity loss in people with signs of the disease A total of 23,099 people were randomised in three trials with treatment duration of 4–12 years for antioxidant supplementation A total of 4,165 people were randomised in eight trials for antioxidant and zinc supplementation v1.1 Page 27 of 91 Evans JR, Fletcher AE, Wormald RPL, Siu-Woon Ng E, Stirling S, Smeeth L, Breeze E, Bulpitt CJ, Nunes M, Jones D, Tulloch A (2002) Prevalence of visual impairment in people aged 75 years and older in Britain: results from the MRC Trial of Assessment and Management of Older People in the Community. British Journal of Ophthalmology, 86: 795-800. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Cluster randomised trial to measure the prevalence of visual impairment in a large representative sample of people aged 75 years and over in the UK community Patients aged 75 years or over at 53 practices in the Medical Research Council general practice research framework (n = 14,600) n/a Prevalence of visual impairment (binocular visual acuity <6/18), categorised separately into low vision (binocular visual acuity <6/18– 3/60) or blindness (binocular visual acuity of <3/60) Age 75–79, 6.2% visually impaired (5.1% to 7.3%); 36.9% at age 90+ (32.5% to 41.3%) Visual impairment is common in the older population and this risk increases rapidly with advancing age, especially for women Strong The prevalence of binocular acuity <6/12 Women had excess risk of visual impairment (OR 1.43, 95% confidence interval 1.29 to 1.58) All patients aged 75 years or over on the general practitioner list were invited to participate, unless they were in long stay hospital or nursing homes, or were terminally ill At age 75–79, 0.6% (0.4% to 0.8%) blind, with 6.9% (4.8% to 9.0%) at age 90+ If visual impairment had been defined as visual acuity of <6/12 (American definition of visual impairment), the age specific prevalence estimates would have increased by 60% 19.9% participants had a binocular acuity of < 6/12 (17.8% to 22.0%) v1.1 Page 28 of 91 Fraser S, Bunce C, Wormald R, (1999) Risk factors for late attendance of chronic glaucoma. Invest Ophthalmol Vis Sci, 40: 2251-7 Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Case– control study to identify the risk factors for having advanced glaucomatous visual field loss on the first visit at hospital eye services Patients newly diagnosed with glaucoma at first visit to one of three ophthalmic departments in the United Kingdom (n = 220; 110 cases, 110 controls). n/a Demographic: age when first assessed, sex, ethnic origin, and Standard Occupational Classification Occupational group, initial IOP, family history of glaucoma, method of referral to hospital, and the number of years since the last visit to an optometrist were found to be independently associated with late presentation Certain subgroups of people with glaucoma are at greater risk of having advanced and irremediable field loss on first visiting the eye services studied Strong Patients with a previous history of ocular hypertension or any documented suspicion of glaucoma (within the hospital eye service) were excluded Ophthalmic: coexisting ocular or medical disease, intraocular pressure (IOP) at initial examination, and frequency of sight testing UK study Estimates of the odds ratios (ORs) of late attendance computed by logistic regression v1.1 Page 29 of 91 Fraser S, Bunce C, Wormald R & Brunner, E. (2001). Deprivation and late presentation of glaucoma: casecontrol study. BMJ. Vol. 322, pt. 7287. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality To identify socioeconomic risk factors for first presentation advanced glaucomatous visual field loss 220 consecutive patients newly diagnosed with glaucoma at three independent eye hospital departments in England (Moorfields Eye Hospital, London; Sunderland Eye Infirmary, Sunderland; Harold Wood Hospital, Essex) Hospital based case-control study with prospective identification of patients using Jarman's underprivileged area score to classify deprivation and identify socioeconomic factors that influence health seeking behaviours Unconditional logistic regression was used to measure the effect of each socioeconomic factor on presenting with advanced glaucomatous field damage Patients who presented with more advanced field loss had higher underprivileged area scores, lower occupational status, and lower education level and were less likely to have access to a car and more likely to be tenants Glaucoma should be included among conditions targeted in policy aimed at reducing social inequalities in health Fit for purpose Case-controlled study UK study Presentation with advanced glaucoma is associated with a poor prognosis 110 participants were late presenters and 110 participants had early onset glaucoma (control group) v1.1 Page 30 of 91 Friedman DS, Hahn SR, Gelb L, Tan MS, Shah SN, Kim EE, Zimmerman TJ, Quigley HA. (2008). Doctor-patient communication, health-related beliefs and adherence in glaucoma. Results from the Glaucoma Adherence and Persistence Study. Ophthalmology. Vol. 115, pp. 1320-7. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Retrospective database and chart reviews in combination with prospective patient surveys to determine drivers of patient adherence to topical ocular hypotensive therapy 300 patients with a new claim diagnosis for openangle glaucoma who initially were prescribed one of three prostaglandins and 103 physicians participating in the same medical plan n/a Self-reported adherence; experiences with medication; communication with the physician; and health-related beliefs Doctor-patient relationship, nonbelief in the effects of medication, financial issues, transport difficulties, ethnic minority origin, not receiving reminders from primary care practices were variables associated with lower medication possession ratio Increased educational efforts by primary care practices may increase glaucoma medication adherence Fit for purpose Phone interviews conducted with participating ophthalmologists Medication possession ratio for adherence v1.1 Page 31 of 91 Friedman DS, Nordstrom B, Mozaffari E, Quigley HA (2005) Glaucoma management among individuals enrolled in a single comprehensive insurance plan. Ophthalmology, 112(9): 1500-4. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Retrospective cohort study to determine the management patterns for glaucoma and suspect glaucoma in newly treated persons People enrolled in a commercial health plan in the United Sates between 1995 and 2001 (n = 1712 diagnosed suspects; 3623 diagnosed glaucoma) n/a Probability of monitoring (return visits, visual fields (VF), and optic nerve head imaging or photography) Median follow-up was 440 days Large proportion of individuals requiring treatment are falling out of care and are being monitored at rates lower than expected from recommendations or published guidelines Fit for purpose Inclusion: 365 days of enrolment before diagnosis; >30 years old when diagnosed; no claim for glaucoma in the 365 days before diagnosis; and no claims for a VF test, fundus photography, or nerve fiber layer imaging in the 12- 2 months before diagnosis Probability of treatment (argon laser trabeculoplasty (ALT) and surgery) for newly treated persons with suspect and glaucoma diagnoses Among diagnosed suspects, 83% had a follow- visit to either an optometrist or ophthalmologist. Among diagnosed glaucoma, 84% attended a follow-up visit Surgery was performed in 1.4% of suspects and 2.1% with diagnosed glaucoma Non-UK study More research is needed to confirm the findings and to determine the reasons for loss to follow-up and low monitoring rates ALT performed in 6% with diagnosed glaucoma and 2% of diagnosed suspects v1.1 Page 32 of 91 Friedman DS, Wolfs RCW, O'Colmain BJ, Klein BE, Taylor HR, West S, Leske C, Mitchell P, Congdon N, Kempen J, Tielsch J for the EDPRG (2004), 'Prevalence of open angle glaucoma among adults in the United States'. Archives of Ophthalmology, 122: 532-538. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality To estimate the prevalence and distribution of openangle glaucoma (OAG) in the United States by age, race/ethnicity, and gender Dependent upon original study included in the review n/a Estimates OAG for Black, white and Hispanic persons, measured in 5-year age intervals starting at 40 years old Pooled data for European-derived studies found a strong increase in the prevalence of OAG with age (P<0.001) Open-angle glaucoma affects more than 2 million individuals in the United States Fit for purpose but heterogeneity in original studies Data for black subjects derived from a single study. The prevalence of OAG increased with age, and OAG consistently more prevalent than in white subjects Owing to the rapid aging of the US population, this number will increase to more than 3 million by 2020 Black, white and Hispanic persons with OAG Eight studies (n = 37,229), Barbados Eye Study; Beaver Dam Eye Study; Blue Mountains Eye Study; Kongwa Eye Project; Melbourne Vision Impairment Project; Proyecto Vision Evaluation Research; Rotterdam Study, Salisbury Eye Evaluation Covariates: age and race/ethnicity Odds ratios (ORs) calculated for relevant variables Age-adjusted prevalence in Black subjects almost 3 times that of white subjects v1.1 Non-UK study More research and better data needed Page 33 of 91 Gehlbach P, Li T, Hatef E. Statins for age-related macular degeneration. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006927. DOI: 10.1002/14651858.CD006927.pub2. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Systematic review to examine the effectiveness of statins compared with other treatments, no treatment, or placebo in delaying the onset and/or progression of age-related macular degeneration (AMD) Dependent upon original study included in the review Study one: simvastatin, 20 mg/day) versus placebo for 3 months Study one: serum cholesterol levels; visual acuity; microscopic eye exam; fluorescein angiography; ERG, and VEP. Measures obtained at baseline, 3 months and 4.5 months Two studies There is insufficient evidence from RCTs to suggest that taking statins may delay the onset and progression of AMD Strong People diagnosed as having early stages of AMD with no signs of choroidal neovascularization (CNV) Two randomised, placebo-controlled trial studies: study one completed (n = 30); study two ongoing (n = 85 participants enrolled; follow-up at six, 12 and 18 months = 60, 42 & 15, respectively) Study two: Two tablets of simvastatin, 20 mg each, daily, compared to a placebo with an identical appearance for 3 years Study two: progression of high risk early AMD to late AMD, evaluated every 6 months. Secondary outcomes colour sensitivity; flicker sensitivity; bleach recovery, and kinetics of dark adaptation v1.1 Study one: no statistically significant difference between the simvastatin and placebo arm in visual acuity. Visual acuity was similar at 45 days after the completion of treatment Study two: no statistically significant difference between control and treatment groups in visual acuity, drusen score or visual function at 12 months followup Page 34 of 91 Goyal R, Shankar and J, Sullivan S (2004) Referrals for cataract surgery: variations between different geographic areas within a Welsh Health Authority. Eye, 18: 773–777 Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Prospective study to identify variations in cataract presentation across the same health authority and to identify any correlation between cataract presentation and social deprivation indices Patients aged 50 years plus presenting to cataract preassessment clinics over a 2-month period at three hospitals in Wales (n = 112) n/a Ophthalmic: Visual acuity, AMD, glaucoma, diabetic retinopathy, corneal opacity; Visual Function Index (VF14) Demographics were similar to National Cataract Audi Variations in cataract presentation correlate well with social deprivation indices and poor use of optometric services Fit for purpose Inclusion criteria included senile cataract on the first eye Demographic: Age, Sex, diabetes mellitus, hypertension, heart disease, and Social deprivation statistics Waiting time for outpatient appointment, and surgery, and frequency of optometrist visit v1.1 The hospital with the lowest visual acuity in both listed and fellow eye, and the lowest VF-index had the longest outpatient and surgery waiting times. The population also visited their optician least frequently UK study Local policies are needed to redress these inequalities and raise public and professional of causes of poor sight in the elderly population Page 35 of 91 Gray TA, Harper RE, Orton LC, Henson DB, et al (2009). Interventions for improving adherence to ocular hypotensive therapy. Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A systematic review to summarise the effects of interventions for improving adherence to ocular hypotensive therapy in people with ocular hypertension (OHT) or glaucoma Dependent of original studies included in review Randomised controlled trials (RCTs) and quasi RCTs that compared interventions to improve adherence to ocular hypotensive therapy for patients with OHT or glaucoma Primary outcomes: persistence with therapy measured by repeat prescription or dispensing counts, or both Eight trials met inclusion criteria Interventions involving simplified dosing regimes, reminder devices, education and individualised care planning, did show improvements in adherence rates Strong Patients with a clinical diagnosis of glaucoma or OHT who were prescribed ocular hypotensive therapy, no limits were set for age and gender Secondary: intraocular pressure reduction; progression of optic nerve head damage; progressive visual field loss; adverse events; and quality of life measures v1.1 Three of five drug comparison studies suggest reducing the frequency of OHT drops improves adherence A small study found a reminder device beneficial to adherence yet only one of two studies involving individualised care planning was found to be successful Inadequate methodological quality and heterogeneity of study design so no particular intervention can be advocated Page 36 of 91 Green J, Siddall H, Murdoch I (2002) Learning to live with glaucoma: a qualitative study of diagnosis and the impact of sight loss. Social Science and Medicine, 55: 257-267. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions/ Quality Qualitative study aimed to identify triggers to selfreferral for glaucoma symptoms in a sample from Britain, and to explore the meaning of symptoms for people living with moderate to severe glaucoma Patients (n = 28) sampled from two hospitals; one specialist urban eye hospital and one District General Hospital n/a How participants first noticed problems with their eyesight; the process of referral to hospital; the impact of symptoms and treatment regimes on their everyday lives; hopes for the future Participants reported low levels of awareness of glaucoma prior to diagnosis Health promotion is a priority to increase public awareness of the existence and symptoms of glaucoma Fit for purpose Visual function deficits from severe or moderately severe open angle glaucoma with no other significant ocular pathology Gradual onset meant participants had learnt to cope with diminishing sight Managing in a 'sighted world' caused problems with everyday living, work and family life. Problems shaped primarily by social factors Twenty in-depth one-to-one interviews. Two group interviews (n = 4 each group) v1.1 UK study More attention could be given to reducing the environmental and social causes of disability Page 37 of 91 Gulliford MC, Dodhia H, Chamley M, McCormick K, Mohamed M, Naithani S, Sivaprasad S (2010a) Socioeconomic and ethnic inequalities in diabetes retinal screening. Diabetic Medicine, 27: 282-288. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality To quantify socioeconomic and ethnic inequalities in diabetes retinal screening Data from the retinal screening programme for three South London boroughs for the 18month period to February 2009 (n = 59,495 records from 31,484 subjects) n/a Ophthalmic: sight threatening diabetic retinopathy (STDR) Non-attendance was highest in young adults aged 18-34 years and in those aged 85 years or greater Socio-economic inequality in diabetes retinal screening may be smaller than reported in earlier studies Fit for purpose Demographics: age group, duration and type of diabetes, self-reported ethnicity and deprivation quintile by participant postal code Odds ratio adjusted for specific outcome measure v1.1 Non-attendance was significantly higher in the most deprived quintile compared with the least deprived quintile UK study The study suggested an increased frequency of diabetic maculopathy among participants of African origins Compared with white Europeans, STDR was higher in Africans and African Caribbeans Page 38 of 91 Gulliford MC, Dodhia H, Sivaprasad S, Ashworth M (2010) Family Practices’ Achievement of Diabetes Quality of Care Targets and Risk of Screen-Detected Diabetic Retinopathy. PLoS ONE 5(4): e10424. doi:10.1371/journal.pone.0010424 Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Determine whether family practices’ achievement of diabetes quality of care targets is associated with diabetic retinal disease in registered patients Patients at 144 family practices located in three London boroughs that contributed data to NHS Quality and Outcome Framework (QOF) for the years 2004/5 to 2007/8 (n = 24,458) n/a Ophthalmic: diabetic retinopathy (DR) and sight threatening diabetic retinopathy (STDR) 9,332 (38%) patients had DR and 2,819 (11.5%) had STDR The risk of diabetic retinopathy might be lower at family practices that consistently achieve highly on diabetes quality of care targets for HbA1c Strong QOF targets: proportion of patients with HBA1c 7%, by quartile Covariates: age group, gender, type of diabetes, duration of diabetes and Indices of Multiple Deprivation (IMD) Odds ratio adjusted for relevant outcome measures v1.1 Relative odds of diabetic retinopathy were 0.78 (0.69-0.88; Sig.) among participants registered at practices in the highest quartile for achievement of the HbA1c target, compared to relative odds of 1.16 (1.031.30; Sig.) for practices consistently in the lowest quartile UK study In the highest achieving practices, the relative odds of STDR were 0.77 (0.65 to 0.92; Sig.) Page 39 of 91 Hawthorne K, Robles Y, Cannings-John R, Edwards AG. (2008). Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trials. Diabet Med, 27(6): 613-23. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusion Quality Systematic review assessing the effectiveness of culturally appropriate diabetes health education on important outcome measures in type 2 diabetes Dependent upon original studies included in review Dependent upon studies Primary outcomes: biomedical measures (blood pressure), patient centred measures (quality of life scales) Glycaemic control (HbA1c), improved after culturally appropriate health education but effect not significant 12 months later Strong Secondary outcomes: (BMI, lipid levels, acute hospital admissions), patient centred measures (attitude scales, patient satisfaction scores, patient empowerment and self efficacy) Knowledge scores improved in the intervention groups at all stages after intervention A need for longterm, standardised multi-centre RCTs to compare different types of culturally appropriate health education within defined ethnic minority groups People with type 2 diabetes mellitus( any duration, with or without complications, from an ethnic minority group living in middle to high income countries Eleven trials involving 1,603 people included in the review v1.1 Other outcomes no significant difference between groups No evidence of clinical outcome improvement over time despite improvement in intermediate issues Page 40 of 91 Janghorbani M, Jones R, Allison S (2000) Incidence of and risk factors for cataract among diabetes clinic attendees. Ophthalmic Epidemiology, 77(1): 13 – 25. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusion Quality Study to estimate the incidence of and risk factors for proliferative diabetic retinopathy (PDR) among insulin- and non-insulindependent diabetics Patients with insulin- and noninsulin-dependent diabetes attending three outpatient clinics at a hospital in Nottingham, England (n = 3482) n/a Ophthalmic: diagnosis of PDR and nonproliferative diabetic retinopathy (NPDR). Incidence of PDR nearly three times higher in patients with (NPDR) as in those without any retinopathy (42.1 vs. 15.0 per 1000 person-years) The risk of blindness was greater among those with PDR than those with NPDR in all three types of diabetes, but was substantial even for those without retinopathy Fit for purpose Covariates: Gender; age; smoking history; glycosylated haemoglobin (HbA1); systolic blood pressure; duration of diabetes; creatinine and proteinuria Duration of diabetes only independent predictor of PDR for patients without PDR or any retinopathy Gender, age, BMI, creatinine, proteinuria and smoking, had no significant association with PDR v1.1 Page 41 of 91 Jones HL, Walker EA, Schechter CB, Blanco E (2010) Vision is precious: a successful behavioural intervention to increase the rate of screening for diabetic retinopathy for inner-city adults. Diabetes Educator, 36(1): 118-126. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusion Quality Part of a randomized controlled study (Vision is Precious stuffy ) to examine the impact of a telephone intervention to increase the rate of diabetic retinopathy screening among implementation with English and Spanish speakers Adults with diabetes living in New York (n = 305; telephone interview group) Telephone intervention from trained health educators who were ethnically diverse and representative of the community Documented receipt of a dilated fundus examination (DFE) within the 6-month study window Nearly all participants who obtained a DFE did so after 4 or fewer calls. All did by the fifth call. The telephone intervention was highly successful compared with the print intervention Strong Participants were part of the Vision is Precious study Participants in the intervention group who did not receive a DFE had significantly more steps in the behavioural process A negative association between the time spent building rapport and receipt of DFE Non-UK The study demonstrates the difficulties and challenges of conducting a tailored telephone intervention to improve rates of screening in an underserved, diverse urban community As time spent in educational activities increased, so did likelihood of receiving a DFE v1.1 Page 42 of 91 Khunti K, Kumar S, Brodie J (2009) Diabetes UK and South Asian Health Foundation recommendations on diabetes research priorities for British South Asians. Diabetes UK, 2009. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Review report to highlight the gaps in the understanding of diabetes in the UK-based South Asian population as well as to identify recommendations and priorities for future research areas Dependent upon original study included in the review n/a Various, including epidemiology, genetics, cultural aspects, screening and prevention, self-management and education, treatment and care, diabetic nephropathy, and diabetic retinopathy Type 2 diabetes is up to six times more common in people of South Asian descent. Various Fit for purpose South Asian population Priority areas for future research identified Prevalence of retinopathy is greater among South Asians compared to white Europeans. Differential risk of retinopathy between South Asians and white Europeans is largely observed in those with diabetes duration of less than 10 years v1.1 Page 43 of 91 Kirkwood BJ, Pesudovs K, Latimer P, and Coster DJ. (2006) The efficacy of a nurse-led preoperative cataract assessment and postoperative care clinic. Medical Journal of Australia, 184: 278–281. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Prospective study to describe the implementation of a nurse-led preoperative cataract assessment and postoperative care clinic and to assess the safety, efficacy and outcomes Patients referred to the Department of Ophthalmology at an Australian hospital for cataract surgery between February 2003 and August 2004 (n = 185; 221 eyes) Nurse-led preoperative assessment clinic and nurse managed postoperative care Concordance between nurse practitioner and ophthalmologist assessments; waiting times for first clinic appointment and surgery; visual acuity and degree of visual disability; patient satisfaction Median waiting times fell from 115 days to 21 days for initial clinic appointment, and from 44 days to 29 days for surgery A nurse-led cataract assessment clinic can improve access to care for public patients with cataracts. Fit for purpose v1.1 All patients had improved visual ability and high levels of satisfaction. Quality assurance evaluations demonstrated full concordance between nurse and ophthalmologist assessments The safety and efficacy of the program and its excellent visual and patient-centred outcomes commend its adaptation and implementation to other ophthalmology departments Page 44 of 91 Klein, BE (2007) Overview of Epidemiologic Studies of Diabetic Retinopathy. Ophthalmic Epidemiol, 14: 179 183. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A review of recent advances in diagnosis, treatment, temporal trends, and health care for diabetic retinopathy (DR) Dependent upon original study included in the review n/a Dependent upon original study included in the review Dependent upon original study included in the review Studies of the variability of diabetic retinopathy have demonstrated the high prevalences and incidences of this condition Fit for purpose Mainly prevalence of diabetic retinopathy Observational studies and clinical trials have documented the importance of glycemic and blood pressure control in the development and progression of diabetic retinopathy v1.1 Page 45 of 91 Klein R, Klein BE, Knudtson MD, Wong TY, Cotch MF, Liu K, Burke G, Saad MF, Jacobs DR Jr. (2006) Prevalence of age-related macular degeneration in 4 racial/ethnic groups in the multi-ethnic study of atherosclerosis. Ophthalmology, 113(3): 373-80. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Prospective cohort study to examine the prevalence of age-related macular degeneration (AMD) in 4 racial/ethnic groups Participants aged 45 to 85 years old from 4 racial/ethnic groups (white, black, Hispanic, and Chinese) that participated in the second examination of the Multi-ethnic Study of Atherosclerosis (MESA; n = 6176) n/a Ophthalmic: presence of AMD Prevalence of AMD were 2.4% (black), 4.2% (Hispanic), 4.6% (Chinese), to 5.4% (white); significant difference between all groups Low prevalences of AMD were found in the MESA cohort in all groups Strong Covariates: age, pupil size, presence of hypertension, presence of diabetes, alcohol intake, current smoking status, and body mass index Participants drawn from 6 United States Communities The highest prevalence of any AMD occurred in those 75 to 84 years old Non-UK study A lower prevalence of AMD was found in blacks compared with whites. The higher prevalence of exudative AMD in Chinese needs further study Age, gender, pupil size, body mass index, smoking, alcohol intake, diabetes, and hypertension status did not explain the variability in the 4 groups v1.1 Page 46 of 91 Lacey J, Cate H, Broadway DC. (2009). Barriers to adherence with glaucoma medications: a qualitative research study. Eye. Vol. 23, pt. 4. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Better understanding of obstacles to, and the motivations for, adherence with glaucoma medication and potential methods to improve adherence 24 participants with moderate to severe glaucoma who attended NHS ophthalmic departments at Norfolk and Norwich University Hospital and Cromer and District Hospital Qualitative measures (focus groups, questionnaires) to investigate various aspects of adherence to glaucoma medications Framework analysis and NVIVO software to check data reliability Multiple obstacles to adherence were identified, including poor education, lack of motivation, forgetfulness, drop application, and other practical issues, together with specific individual and age differences. Motivation for adherence was determined by fear of blindness and a faith in drop efficacy Specific obstacles to adherence with anti-glaucomatous therapy should be identified early after diagnosis. Tailored education about consequences may improve patients motivations for adherence Fit for purpose: no intervention, reasonable inferences 7 participants were included in two focus groups (one at each hospital, total participants = 14) and 10 participants completed a questionnaire v1.1 UK Study More research needed on how to deliver education about glaucoma management Page 47 of 91 Leese GP, Ahmed S, Newton RW, Jung RT, Ellingford A, Baines P, Roxburgh S, Coleiro J (1993) Use of mobile screening unit for diabetic retinopathy in rural and urban areas British Medical Journal, 306: 187–189. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusion Quality Prospective study to examine the effectiveness of a mobile screening unit in detecting diabetic retinopathy (DR) in rural and urban areas Patients in the Tayside region of Scotland presenting for diabetic retinopathy screening over a two year period (n = 2186) n/a Ophthalmic: presence of diabetic Retinopathy; and need for laser photocoagulation Patients in rural areas less likely to attend a hospital based diabetic clinic (p <0.001) Fit for purpose Covariates: age; duration of diabetes; and diabetic treatment Correcting for age, patients in rural areas more likely to have advanced DR (p < 0001) and require laser photocoagulation for previously unrecognised retinopathy (p < 0.02) Mobile diabetic eye screening detected a greater prevalence of advanced retinopathy in diabetic patients living in rural areas Screening cost £10 per patient and £1000 per patient requiring treatment v1.1 Patients in rural areas were more likely to need urgent laser photocoagulation Rural patients may benefit more from mobile screening units than urban patients Page 48 of 91 Leese GP, Boyle P, Feng Z, Emslie-Smith A, Ellis JD. (2008). Screening uptake in a well-established diabetic retinopathy screening program: the role of geographical access and deprivation. Diabetes Care. Vol. 31, pt. 11. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality To identify criteria that affect uptake of diabetes retinal screening in a community screening program using mobile retinal digital photography units 16, 258 (average age 63+ years) patients with diabetes in 69 general practices in Tayside, Scotland. Eye screening data from 15, 150 patients was included in the study Patients assigned anonymously to census based geographical areas based on residential postcodes and comparisons made regarding uptake of screening services (static and mobile) Geographical information systems were used to measure geographical data and ‘Carstairs’ deprivation scale to measure deprivation Highest proportion of non-attendees came from urban and deprived areas (with the exception of Dundee) even though these patients had the shortest distance to travel Static screening centres are more effective than mobile centres Strong Random effects logit models were used to model the propensity of missing eye screenings v1.1 Younger people and patients with a long history of diabetes were also likely to miss the screening Social deprivation is strongly associated with non attendance but geographical distance seems to have no effect Further improvement is needed to reach those in socially deprived areas Page 49 of 91 McLaughlan B, Edwards A (2010) Understanding of the Purpose of an Eye Test Among People Aged 60 and Over in the UK. Optometry in Practice; 11:4 179–188. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Cross sectional study to examine the barriers to eye examinations among older people Members of the 50plusview panel aged 60+ (n = 3848) n/a General perceptions about the frequency and purpose of eye tests Nearly half of respondent attend for an eye exam every year People fear being blind to a greater extent than other disabilities Fit for purpose Personal experience and attitudes towards eye tests Top three reasons given for an eye exam: check prescriptions; check health of the eyes; and early detection of eye disease. ‘Most important reason’, detection of eye disease The overwhelming majority of respondents cited checking prescriptions as a reason for having an eye test Self reported questionnaire administered across the UK Top three reasons for non attendance: not had an eyesight problem; expense of glasses; not considered it necessary v1.1 The most frequently given reason for not having had an eye test is not having had any eyesight problems Page 50 of 91 McLaughlan B, Winyard S (2007) Don’t blame the patient! A call for action to eliminate unnecessary sight loss from glaucoma. RNIB campaign report 27. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality RNIB Campaign Report – consensus report from series of expert meetings and literature review to summarise evidence on compliance in Glaucoma treatment n/a n/a Based on registrations and summarises findings from other studies Highlights key risk factors and importance of adherence to treatment plans as well as early detection Need of a concerted strategy including better pathways and attitude to compliance in design Weak but fit for purpose v1.1 Page 51 of 91 McNeil, JJ Robman, L Tikellis, G Sinclair, MI McCarty, CA Taylor, HR (2004). Vitamin E supplementation and cataract: randomized controlled trial. Ophthalmology. Vol. 111, pt. 1. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A prospective, randomized, double-masked, placebo-controlled clinical trial to determine whether treatment with vitamin E (500 IU daily) reduces either the incidence or rate of progression of agerelated cataracts 1, 193 volunteers with early or no cataract aged 5580 years in a screening program in Melbourne, Australia were randomly assigned to the intervention or control group Participants were assigned randomly to receive either 500 IU of natural vitamin E in soybean oil encapsulated in gelatin or a placebo with an identical appearance The incidence and progression rates of age-related cataract were assessed annually for four years with both clinical lens opacity gradings and computerized analysis of Scheimpflug and retroillumination digital lens images obtained with a Nidek EAS-1000 lens camera 87% (74% = intervention, 76% = control) of participants competed the four years cycle. Vitamin E has no effect on the incidence and progression of all types of cataract Strong v1.1 Vitamin E did not reduce the incidence or progression of any type of cataract Page 52 of 91 Mikelberg FS, Schulzer M, Drance SM, Lau W (1986) The rate of progression of scotomas in glaucoma. Am J Ophthalmol., 101(1): 1-6. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Retrospective study to evaluate the rate of progression of scotomas Patients with glaucoma for whom demographic data were stored on computerised records in an ophthalmology clinic in Canada (n = 45) n/a Ophthalmic: scotoma mass, calculated and regressed on time to obtain the rate of visual field change Twenty-two eyes (49%) showed a linear type of progression, nine (20%) showed a curvilinear progression, three (7%) showed episodic progression, and 11 (24%) showed no significant progression Nerves may be lost in the optic nerve with minimal changes to visual field Fit for purpose Only patients with routine open angle chronic glaucoma included. Patients with low tension glaucoma were excluded After a certain point, loss of visual field is more linear and rapid as little functional nerve remains intact A progressive study is required on progression of field loss in glaucoma as well as the factors that may influence progression of the disease v1.1 Page 53 of 91 Muir KW, Santiago-Turla C, Stinnett SS et al. (2009). Glaucoma patients' trust in the physician. Journal of Ophthalmology. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusiosn Quality A cross-sectional patient survey to describe glaucoma patients' trust in the physician and to test the hypothesis that increased interpersonal trust is associated with increased medication adherence 195 participants with open-angle glaucoma seen by multiple glaucoma subspecialists at Glaucoma Service of Duke University Eye Center, NC n/a Survey including demographic data, the Mini-mental State Exam (MMSE), a word recognition test and the trust in physician scale (TPS) Patients from ethnic minorities had slightly less trust in their physician than white patients A better understanding of the patient – physician relationship between “races” is needed Strong Each participant was seen by one of four glaucoma subspecialists Descriptive statistics for initial results, relationship between demographic data and TPS was assessed using analysis of variance or linear regression v1.1 Non-UK study Trust in physician was not associated with glaucoma medication adherence in this sample population Page 54 of 91 Nazroo J Y (2005) The social determination of ethnic/racial inequalities in health. In Social Determinants of Health (Second Edition), ed. M. Marmot and R.G. Wilkinson, 238-266.Oxford: Oxford University Press, 2005. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Review of previous studies examining the social determination of ethnic/racial inequalities in health Dependent upon original study included in the review n/a Ethnic./racial disadvantage Various There remain ongoing problems with the data to available to explore ethnic inequalities in health Fit for purpose Ethnic patterning of health Socio-economic patterning of health Age Impact of racial harassment and discrimination Social support networks and participation v1.1 A large body of evidence now supports the possibility that ethnic inequalities in health are largely the consequence of socioeconomic differentials but does not explain the relationship between ethnicity and socio-economic inequality Page 55 of 91 Ng, WS, Agarwal PK, Sidiki S, McKay L, Townend J, Azuara-Blanco A (2010) The effect of socio-economic deprivation on severity of glaucoma at presentation. Br J Ophthalmol, 94: 85-87. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Cross sectional study to evaluate the influence of socio-economic factors on severity of glaucoma at presentation All newly diagnosed glaucoma patients at two hospitals in Scotland, in 2006 (n = 126; 48 severe glaucoma; 74 nonsevere glaucoma; 4 not determined) n/a Ophthalmic: severity of glaucoma at presentation Severity of glaucoma at presentation was significantly associated with SIMD rank, being most severe in patients from areas with the lowest ranks Age and socioeconomic deprivation were associated with severity of glaucoma at presentation, with patients from areas of higher socioeconomic deprivation presenting with more advanced glaucoma Fit for purpose Demographics: age and gender Socio-economic: Scottish Index of Multiple Deprivation Age was a significant factor with severe glaucoma being more common in elderly patients v1.1 Page 56 of 91 Nordmann J-P, Baudouin C, Renard J-P, Denis P, Lafuma A, Laurendeau C, Jeanbat V, Berdeaux G (2010a) Measurement of treatment compliance using a medical device for glaucoma patients associated with intraocular pressure control: A survey. Clinical Ophthalmology, 4: 731–739. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Observational survey to identify and characterize treatment compliance profiles of glaucoma patients and evaluate the association with intraocular pressure (IOP) Patients attending specialised glaucoma treatment in 17 centres in France (n = 140) n/a Compliance rates for weekdays and weekends, over 8 consecutive weeks IOP was 23.9 mmHg at baseline and 16.1 mmHg at 8 weeks; 17.7 mmHg in low compliance group AHC identified 3 compliance groups: ‘high’ (56.6%, approx. 80% compliance), ‘medium’ (21.2%, approx. 50% compliance), and ‘low’ (22.1%, approx. 20% compliance) Compliance measurement by a medical device showed compliance rates <80% by 50% (approx.) of patients, significantly impacting IOP control Fit for purpose Demographics: inclusion and exclusion findings, socio-demography, POAG/OHT history, current treatment, IOP and visual acuity Principal components analysis (PCA) and ascendant hierarchical classification (AHC) to identify compliance groups v1.1 No demographic or glaucoma variable was associated with low compliance Demographics and glaucoma parameters did not predict low compliance Page 57 of 91 Nordmann JP, Baudouin C, Renard JP et al (2010b) Identification of noncompliant glaucoma patients using Bayesian networks and the Eye-Drop Satisfaction Questionnaire. Clinical Ophthalmology, 4: 1489-1496. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Observational cross-sectional study To identify poorly compliant glaucoma patients, using the Eye-Drop Satisfaction Questionnaire (EDSQ) Patients with primary open-angle glaucoma (POAG) or ocular hypertension attending specialised treatment at 17 sites in France (n = 169) n/a Eye-Drop Satisfaction Questionnaire Low compliance associated with age <77.5 years plus poor patient– physician relationship The patient– physician relationship plays a central role in the compliance process Fit for purpose Inclusion: used Travalert device eight weeks; 18 years of age; and either POAG or high IOP Compliance profile derived from Travalert® data A Bayesian network (BN) was applied to explore compliance associations with EDSQ Patients aged >77.5 years with a poor patient–physician relationship and declared good compliance High compliance associated with patients < 77.5 years old with good patient-physician relationship Secondary glaucoma excluded v1.1 Age, self-declared compliance, and patient satisfaction with the patient– physician relationship are all dimensions worth exploring before glaucoma medication is switched or proceeding to laser treatment or surgery Page 58 of 91 Nordstrom BL, Friedman DS, Mozaffari E, Quigley HA, Walker AM (2005) Persistence and adherence with topical glaucoma therapy. Am J Ophthalmology. 140(4): 598-606. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A retrospective cohort study to examine the patterns and predictors of treatment persistence and adherence among patients who are diagnosed with glaucoma or as glaucoma suspects Newly treated individuals with diagnosed glaucoma (n = 3623) and suspect glaucoma (n = 1677). Four drug classes were included in the study: betablockers, alphaagonists, carbonic anhydrase inhibitors, and prostaglandin analogs Duration of continuous treatment with the prescribed medication (persistence) Nearly one half of individuals had discontinued all topical ocular hypotensive therapy within six months Patients with diagnosed openangle glaucoma were more likely to adhere to treatment than suspected glaucoma Fit for purpose Prevalence of use of the initial medication at various time points (adherence) 37% of these individuals had refilled their initial medication at three years after first dispensing Patient records obtained from healthcare claims data in the Ingenix Research Database Relative risk (RR) for outcome measures: patients diagnosed with glaucoma vs. glaucoma suspects v1.1 Persistence and adherence were substantially better with prostaglandins than with other drug classes Patients with diagnosed glaucoma more likely to adhere to therapy than with suspect glaucoma (RR = 1.11; 95% CI, 1.05-1.18) Page 59 of 91 Norregaard JC, Bernth-Petersen P, Alonso J, Dunn E, Black C, Andersen TF, Bernth-Petersen P, Bellan L, Espallargues M (1997) International variation in ophthalmologic management of patients with cataracts. Results from the International Cataract Surgery Outcomes Study. Arch Ophthalmol, 115(3): 399–403. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Cross-sectional study to describe international variation in the management of patients with cataracts in 4 health care systems and to discuss the potential implications for cost and utilisation of services Ophthalmologists in the United States (n = 526), Canada (n = 276), Spain (n = 89), and Denmark (n = 82) n/a Most surgeons reported that they performed Ascanning, fundus examination, and refraction routinely before surgery Both within and across sites, considerable variation in number of follow-up visits and postoperative tests was observed Significant international variation in the management of healthy patients with cataracts has been observed Fit for propose Significant crossnational variation was observed in preoperative ophthalmic and medical testing A significantly higher proportion of surgeons in the United States and Spain reported less than 100 extractions per year compared with surgeons in Canada and Denmark (P < .001) If less intensive care is not associated with poorer outcomes, there is the potential for less costly care of patients with cataracts v1.1 Page 60 of 91 O’Donnell K. (2009) Eye care in the UK: Epidemiology, intervention and Ethnicity. PHAST report Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Literature review produced for NHS Tower Hamlets in September 2009 as part of the ‘Care Needs Assessment: Eye Health’ project commissioned by NHS Tower Hamlets Dependent upon original study included in the review n/a Epidemiology and clinical appearance of the four main causes of visual impairment in the UK: glaucoma, cataract, diabetic retinopathy and age-related macular degeneration Various A number of key points emerge from the literature which may be useful when formulating interventions: 1) the importance of family; 2) age is a major risk factor; 3) ethnicity is a determinant of risk: 4) the need for targeted screening and holistic assessment; and 5) investment should be made in low vision services Fit for purpose Interventions and treatments, together with available data on cost analysis or effectiveness. Dependent on the cause of visual impairment and group included in the review The needs of special groups v1.1 Page 61 of 91 O'Hare JP, Raymond NT, Mughal S, Dodd L, Hanif W, Ahmad Y, Mishra K, Jones A, Kumar S, Szczepura A, Hillhouse EW, Barnett AH (2004) Evaluation of delivery of enhanced diabetes care to patients of South Asian ethnicity: the United Kingdom Asian Diabetes Study (UKADS). Diabet Med., 21(12): 1357-65. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Cluster randomized controlled trial to test the hypothesis that enhanced care for diabetes, tailored to the needs of the South Asian community with Type 2 diabetes, would improve risk factors for diabetic vascular complications and ultimately reduce morbidity and mortality Patients at six General Practices in the UK West Midlands, with a high population of South Asians (n = 361; n = 325 ad 12month follow-up) Intervention: 'enhanced care' using Asian link workers, an additional practice nurse session per week and community diabetes specialist nurse input Blood pressure, HbA1c and lipid control after oneyear follow-up At one-year follow-up a significant difference in reduction of systolic and diastolic blood pressure, and total cholesterol, in the intervention groups Small reductions in blood pressure and cholesterol were achieved, but improvement in glycaemic control may require longer different strategies Strong Adjusting for baseline and age, only differential reduction in diastolic blood pressure was significant Using link workers and extra community diabetes specialist nurse input might prove a useful strategy in working towards NSF targets Eligible patients were of South Asian ethnicity with Type 2 diabetes and either elevated blood pressure, elevated glycated haemoglobin (HbA1c) or raised total cholesterol Control: continued standard practice care There was no significant change in HbA1c and no difference between groups v1.1 UK study Further research is required to evaluate effectiveness Page 62 of 91 Okeke CO, Quigley, Jampel HD, Ying G, Plyer RJ, Jiang Y, Friedman DS (2009). Interventions Improve Poor Adherence with Once Daily Glaucoma Medications in Electronically Monitored Patients. Ophthalmology. Vol. 116, pp. 2286-2293. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A randomised controlled trial to investigate the impact of an intervention program to improve adherence with topical, once daily therapy for glaucoma 66 patients aged 18+ years with open angle glaucoma, angleclosure glaucoma, glaucoma suspect, or ocular hypertension attending the Glaucoma Services of the Wilmer Eye Institute and the Scheie Eye Institute in Philadelphia, PA USA Intervention group: educational video, structured discussion, reminder telephone calls Change in drop usage adherence as determined by the DA device Patients in the intervention group mean of scheduled doses increased in the three months after intervention. The control mean adherence rate at baseline was statistically unchanged during the follow up A multifaceted intervention significantly increased adherence with glaucoma medications, further research is needed to determine which components of this intervention were most effective Fit for purpose Statistical analysis of results Control group: standard care v1.1 Page 63 of 91 Pappa C, Hyphantis T, Pappa S, Aspiotis M, Stefaniotou M, Kitsos G, Psilas K, Mavreas V. (2006) Psychiatric manifestations and personality traits associated with compliance with glaucoma treatment. J Psychosom Res, 61(5): 609-17. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Cross-sectional study to assess the impact of psychological distress and personality traits on self-rated compliance with glaucoma treatment Patients with primary open angel glaucoma ((POAG (n = 100) n/a Compliance with treatment: via qualitative interviews Forty-two percent of patients were noncompliers (omitted more than two doses per week). Non-compliers presented more severe symptoms of glaucoma. Depression associated with poor compliance. Adoption of immature defensive style further increased the risk for non-compliance Depression is associated with selfreported noncompliance with glaucoma treatment, whereas certain personality traits are involved in the increased risk for non-compliance Fit for purpose Eligible for entry were patients with either previously diagnosed POAG or exfoliation glaucoma and who had already received ocular hypotensive agents Other types of glaucoma and other ophthalmic conditions were excluded Psychometric outcomes: General Health Questionnaire; Symptom Distress Checklist; Centre for Epidemiological Studies Depression Scale; Defence Style Questionnaire; Hostility and Direction of Hostility Questionnaire v1.1 Non-UK study Page 64 of 91 Pardhan S, Gilchrist J, Mahomed I (2004) Impact of age and duration on sight-threatening retinopathy in South Asians and Caucasians attending a diabetic clinic. Eye, 18(3): 233-40. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusion Quality Prospective study to examine diabetic retinopathy in Asians and Caucasians attending a hospital diabetic clinic Diabetic patients who attended an outpatient diabetic clinic in Bradford between March 1996 and December 1997 (n = 500; 268 Asians, 232 Caucasians) n/a Ophthalmic: existence of sightthreatening Retinopathy (STR) Significant association of STR with race, age and duration of diabetes, with no significant interaction effect between variables After adjusting for age and duration of diabetes, the probability of STR in Asian diabetic patients in Bradford is significantly higher than that in (white) Caucasians Fit for purpose Patients were included if they were over 40 years of age, were diagnosed as diabetic, and had not been treated for any other eye diseases such as glaucoma Covariates: age of the patient; duration of diabetes; gender; insulin-requiring status; and HbA1 levels v1.1 Logistic regression predicted Caucasians are approximately 12.5 years older and/or have had diabetes for 12.5 years more to have the same STR levels compared to Asians UK study The impact of age and duration was significantly higher in patients of South Asian origin compared to (white) Caucasians Page 65 of 91 Patel D, Baker H & Murdoch I. (2006). Barriers to uptake of eye care services by the Indian population living in Ealing, west London. Health Education Journal. Vol. 65, pt. 3. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality This study in Ealing, London was aimed at determining the reasons for poor utilization of eye care services by the Indian population 44 participants male and female from three different stakeholder perspectives of community, patients and health in Ealing took part in the study in community centres, temples and GP practices around the borough n/a Various data collection methods The study found two distinct types of barriers that affected the Indian population of Ealing those that are due to misconceptions about eye diseases and those that come from experience of health and social care services Relationships between GPs and their Indian patients in Ealing need to be examined further Fit for purpose Analysis used a thematic framework involving five distinct steps: (1) Familiarization (2) Identifying a thematic framework (3) Indexing (4) Charting (5) Mapping and interpretation v1.1 Strategies for overcoming identified barriers need to be created Page 66 of 91 Quigley H, & Broman, S (2006) The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmology, 90(3): 262-7. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A review of published data to estimate the number of people with open angle (OAG) and angle closure glaucoma (ACG) in 2010 and 2020 using prevalence models constructed by age, sex, and ethnicity Dependent upon original study included in the review n/a Prevalence models for OAG and ACG by age, sex, and ethnicity, weighting data proportional to sample size of each study 60.5 million people with OAG and ACG in 2010 Glaucoma is the second leading cause of blindness worldwide, disproportionately affecting women and Asians Fit for purpose Data from population based studies of age specific prevalence of OAG and ACG that satisfied standard definitions 79.6 million people with OAG and ACG by 2020. Of these, 74% will have OAG Models were combined with UN world population projections for 2010 and 2020 to derive the estimated number with glaucoma v1.1 Page 67 of 91 Racette L, Wilson MR, Zangwill LM, Weinreb RN, Sample PA. (2003). Primary open-angle glaucoma in blacks: a review. Surv Ophthalmol. May-Jun; 48(3): 295-313. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Review of published literature to inform ongoing ADAGES African Descent and Glaucoma Evaluation Study (USA) n/a n/a Various depending on publications POAG prevalence is estimated six times as high in Black Americans in certain age groups compared to whites. POAG more likely to result in irreversible blindness, appears approximately 10 years earlier and progresses more rapidly in blacks than in whites. Blacks have larger optic disks than whites. Racial differences in intraocular pressure remain unclear There is evidence that blacks are less responsive to both drug and surgical treatment for POAG. They often have reduced accessibility to treatment and are less aware of the risks of having POAG Fit for purpose v1.1 Non-UK study Page 68 of 91 Reidy A, Minassian DC, Vafidis G, Joseph J, Farrow S, Wu J, Desai P, Connolly A (1998). Prevalence of serious eye disease and visual impairment in a north London population: population based, cross sectional study. BMJ. 30; 316(7145): 1643–1646. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Cross sectional survey to estimate the magnitude of serious eye disorders and of visual impairment in a defined elderly population of a typical metropolitan area in England Random sample of people aged 65 and older, drawn from a defined population of elderly people registered with 17 general practice groups (n = 1547) n/a Proportions and population prevalence estimates for visual acuity The population prevalence of bilateral visual impairment was 30%; 72% was potentially remediable Untreated visual impairment and eye disorders affect a substantial proportion of people aged 65 years and older Strong Classified into four categories: prevalence of cataract, age related macular degeneration, and refractive error causing visual impairment and of definite primary open angle glaucoma Status of contact with eye services v1.1 88% of people with cataracts not in touch with the eye services Prevalence of AMD was 8% and of glaucoma 3% Three quarters of people with definite glaucoma were not known to the eye services Page 69 of 91 Rose K, Waterman H, Toon L, Mcleod D, Tullo A (1999) Management of day surgery patients with cataract attending a peripheral ophthalmic clinic. Eye, 13: 71-75 Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality To compare two organisational models of management for patients with cataract referred to a peripheral ophthalmic clinic who underwent daysurgery at a main eye hospital Patients with cataract attending a peripheral ophthalmic clinic Experimental group received preoperative assessment by a trained ophthalmic nurse at the peripheral clinic immediately following diagnosis of cataract and diary-booking for surgery Ophthalmic: visual acuity, subjective visual function (VF14) No significant differences between the experimental and control groups with respect to visual acuity, subjective visual function or anxiety and depression Nurse-led preoperative assessment of patients with cataract at a peripheral ophthalmic clinic is safe, cost-effective and is preferred by patients Strong Patients were randomly drawn to receive either an experimental (group A; n = 25) or control (group B; n = 24) model of care Anxiety and depression Patient satisfaction Cost-benefit analysis The control group received a separate appointment for preoperative assessment at the main hospital The experimental model was a more cost-effective means of care delivery Overall, patients preferred the experimental model v1.1 Page 70 of 91 Rudnicka AR, Mt-Isa S, Owen CG, Cook DG, Ashby D (2006) Variations in Primary Open-Angle Glaucoma Prevalence by Age, Gender, and Race: A Bayesian Meta-Analysis. Investigative Ophthalmology & Visual Science. 47:4254–4261. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A systematic review to quantify the variation in primary open-angle glaucoma (OAG) prevalence with age, gender, race, year of publication, and survey methodology Dependent upon original study included in the review n/a Number of people and cases of OAG by age, race, and gender Black populations had the highest OAG prevalence at all ages, but proportional increase with age was highest in white populations Although black populations had the highest prevalence of OAG at all ages, white populations showed the steepest increase in OAG prevalence with age Strong Very sophisticated statistical approach NB ‘Asian’ may not compare to UK usage of term. Only ‘Asian’ study based on Japanese cases, and classifies Chinese, Eskimo (Inuit) and Thai as ‘Asian’ Forty-six published observational studies of OAG prevalence were included (n = 103,567 participants; 2509 cases of OAG) Population-based surveys were included that examined an entire town/ village/ geographic region or used clearly defined random or clustered sampling Information on whether the definition of glaucoma relied on raised intraocular pressure (IOP) and whether visual field examination Bayesian model associations between log odds of OAG and age, race, gender, year of publication, method of visual field testing, and reliance on IOP v1.1 Prevalence in those older than 70 was 6% in whites, 16% in blacks, and 3% in Asians Prevalence of OAG was one third lower in studies in which visual fields were not assessed and IOP was used in the definition of glaucoma Men were more likely than women to have OAG Page 71 of 91 Salisbury C, Wallace M, Montgomery AA (2010) Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling. BMJ, 341:c5004 Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Secondary analysis of data from a study of access to general practice, to explore whether responses to questions of patients that purport to assess the performance of general practices or doctors, reflect differences between practices, doctors, or the patients themselves Secondary analysis of data obtained from a survey of patients’ satisfaction done in 47 practices in 9 primary care trusts in England, in 2005-6 (n = 4573 patients who consulted 150 different doctors in 27 practices) n/a Overall satisfaction; experience of wait for an appointment; reported access to care; satisfaction with communication skills Wait for an appointment more discriminating than overall satisfaction Measures related to patients’ experience discriminate more effectively than do measures of general satisfaction Fit for purpose 79% of the variance occurred at the patient level Patients' age, sex, ethnicity, and housing and employment status explained some variation Adjustment for patients’ characteristics made very little difference to practices or the individual ranking v1.1 Surveys of patients satisfaction fail to distinguish between individual doctors because most variation in doctors’ performance is due to differences between patients and random error rather than differences between doctors Page 72 of 91 Saxena S, Misra T, Carr J, Netuveli G, et al. (2007). Systematic review of primary healthcare interventions to improve diabetes outcomes in minority ethnic groups. Journal of Ambulatory Care Management. Vol. 30, pt. 3, pp. 218-30. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality To systematically review the effectiveness of primary care interventions on glycaemic control and cardiovascular risk factors in minority ethnic groups with diabetes Dependent upon original studies included in review Dependent upon study Statistical analysis Two main models of care were identified: (1) case management, with specialist diabetes nurses and community health workers and (2) the use of the services of link workers from minority ethnic groups to guide people with diabetes Case management in minority ethnic groups with diabetes, improves glycaemic control and cardiovascular risk factors Strong 2, 565 participants form 9 separate studies based in primary care practices v1.1 Link workers improve control of cardiovascular risk factors Relative effectiveness, cost, and sustainability over time warrant further evaluation Page 73 of 91 Scanlon PH, Carter SC, Foy C, Husband RFA, Abbas J and Bachmann MO (2008) Diabetic retinopathy and socioeconomic deprivation in Gloucestershire. J Med Screen 2008;15:118–121 Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A cross-sectional study to investigate socioeconomic variations in diabetes prevalence, uptake of screening for diabetic retinopathy, and prevalence of diabetic retinopathy (DR) Individual level records from the Gloucestershire Diabetic Eye Screening Service (GDESS) database n/a Diabetes prevalence with odds ratios, uptake of screening, prevalence of any retinopathy and prevalence of sightthreatening retinopathy (STDR) at screening compared for different area deprivation quintiles With each quintile of deprivation, diabetes prevalence increased, probability of being screened for DR decreased, and prevalence of STDR in screened patients increased The National Screening Programme needs to attract socioeconomic deprived groups to attend, as these people are at the most risk of STDR Strong Data from 85 GP practices Dataset 1 — all patients on the GDESS database at December 2002. Dataset 2 — patients who had been screened for diabetic retinopathy up to February 2003 Logistic regression was used to adjust for confounding v1.1 Prevalence of nonsight-threatening diabetic retinopathy was unchanged with each increasing quintile of deprivation Page 74 of 91 Scully ND, Chu L, Siriwardena D, Wormald R, Kotecha A (2009) The quality of optometrists’ referral letters for glaucoma. Ophthalmic and Physiological Optics, 29(2): 26-31. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Prospective study to evaluate the quality of content of optometrist-initiated glaucoma referral letters arriving at the appointment booking centre of a London based eye hospital All new glaucoma referral arriving at the appointment booking centre of a London based eye hospital over a 4month period commencing in December 2006 (n = 121) n/a Quality of the referral letter Forty-nine per cent of referral letters found of acceptable quality, 7% ideal and the remainder classed as fail There is a need to improve the quality of optometrists' glaucoma referral letters, particularly with respect to completion of all the items set out on the GOS 18 referral form Fit for purpose Referrals for patients with previously diagnosed or previously suspected glaucoma were omitted Acceptable: all information on General Ophthalmic Services (GOS) 18 referral form Ideal: as above plus risk factors, visual field assessment, optometrist's diagnosis and referral speed Fail: letters not satisfying all criteria v1.1 Main reason for failure was an omission of nonclinical information Two-thirds of acceptable letters lacked discussion of risk factors, visual field analysis or recommendations for referral speed Page 75 of 91 Seddon JM, George S, Rosner B (2006) Cigarette Smoking, Fish Consumption, Omega-3 Fatty Acid Intake, and Associations With Age-Related Macular Degeneration. The US Twin Study of Age-Related Macular Degeneration. Arch Ophthalmol. 124:995-1001 Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality To evaluate modifiable risk and protective factors for age-related macular degeneration (AMD) among elderly twins Male twins from the National Academy of Sciences– National Research Council World War II Veteran Twin Registry n/a Ophthalmic: signs of AMD using slitlamp Biomicroscopy. Retinal photography Current smokers had a 1.9-fold increased risk of AMD Cigarette smoking increases the risk of AMD while fish consumption and omega-3 fatty acid intake reduce risk of AMD Strong Cohort includes n = 681 twins: 222 twins with AMD (intermediate or late stages) and 459 twins with no maculopathy or early signs Dietary: food frequency questionnaires Risk factors: demographic characteristics, cigarette smoking, alcohol intake, and physical activity Past smokers had about a 1.7-fold increased risk Non-UK study Increased intake of fish reduced risk of AMD, particularly for 2 or more servings per week Odds ratio for specific outcome measure v1.1 Page 76 of 91 Smeeth L, Fletcher AE, Hanciles S, Evans J, Wormald R (2003) Screening older people for impaired vision in primary care: cluster randomised trial. BMJ, 327: 1027-1032. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusion Quality Cluster randomised trial to determine the effectiveness of screening for visual impairment in people aged 75 or over as part of a multidimensional screening programme People aged 75 years or over randomly sampled from 20 general practices (n = 4340) Visual acuity testing and referral to eye services for people with visual impairment Proportion of people with visual acuity less than 6/18 in either eye Universal screening (assessment and visual acuity testing) was compared with targeted screening, in which only participants with a range of health related problems were offered an assessment that included acuity screening Including a vision screening component by a practice nurse in a pragmatic trial of multidimensional screening for older people did not lead to improved visual outcomes Strong People resident in hospitals or nursing homes were excluded 3-5 years after screening, the relative risk of visual acuity < 6/18 in either eye, (universal vs. targeted screening), was 1.07 (95% CI 0.84 to 1.36; NS) Mean composite score of 25 item version of the National Eye Institute visual function questionnaire v1.1 Mean composite score of visual function questionnaire 85.6 in targeted screening group and 86.0 in the universal group (difference 0.4, 95% CI 1.7 to 2.5, NS) Page 77 of 91 Smith W, Assink J, Klein R, Mitchell P, Klaver CC, Klein BE, Hofman A, Jensen S, Wang JJ, de Jong PT. (2001) Risk factors for age-related macular degeneration: Pooled findings from three continents. Ophthalmology, 108(4): 697-704. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Combined analysis of population-based eye disease prevalence data to assess the prevalence and potential risk factors for late age-related macular degeneration (AMD) in three racially similar populations from North America, Europe, and Australia Participants with gradable photographs from the Beaver Dam Eye Study (n = 4756), Rotterdam Study (n = 6411), and Blue Mountains Eye Study (n = 3585) n/a Ophthalmic: presence of AMD (geographic atrophy (GA) and neovascular NV) AMD present in 0.2% of the combined population aged 55 to 64 years, rising to 13% of population older than 85 years The study provides strong and consistent evidence that tobacco smoking is the principal known preventable exposure associated with any form of AMD Strong Covariates: age, gender, tobacco smoking, body mass index, presence of hypertension, cholesterol, iris colour, age at menopause, and hormone replacement therapy v1.1 No significant gender differences in the prevalence of AMD (either NV or GA) Age and smoking the only risk factors associated with any form of AMD in sites separately and in pooled analyses Page 78 of 91 Stryker JE, Beck AD, Primo SA, Echt KV, Bundy L, Pretorius GC, Glanz K (2010) An exploratory study of factors influencing glaucoma treatment adherence with medication taking, prescription refills and appointment keeping to develop an intervention for a specific population. Journal of Glaucoma 19(1): 66-72. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Qualitative study to understand the factors that influence glaucoma treatment adherence with medication taking, prescription refills, and appointment keeping Patients attending two eye clinics located in hospitals in the Southeast United States, aged between 18 and 80 (n = 80) n/a Participant’s eye condition, prescription medication usage, facilitators and barriers to medication adherence, refill and clinic visit behaviour, medication knowledge and health literacy, psychosocial factors such as selfefficacy, attitudes, and social support Non-adherent participants less likely to believe their eye doctors spent sufficient time with them; ask if they had any questions; know the benefits of medication; and have someone help them take their medications Non-adherent glaucoma patients struggle with a variety of issues related to consistent use of glaucoma medicine and routine eye care Fit for purpose Patients diagnosed with open angle glaucoma, glaucoma suspect or ocular hypertension Patients were taking daily doses of topical glaucoma treatments for at least the past year v1.1 Non-adherent participants more likely to have difficulty remembering to take medications and to believe glaucoma would affect their eye sight in the future Non UK study Interventions are needed to address these modifiable factors related to glaucoma treatment adherence Page 79 of 91 Sukumar S, Spencer F, Fenerty C & Harper R. (2009). The influence of socioeconomic and clinical factors upon the presenting visual field status of patients with glaucoma. Eye. Vol. 23, pt. 5. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A cohort review investigating the relationship between socioeconomic status and the extent of visual field loss in POAG and treated OHT patients at their first presentation 113 glaucoma patients seen between 1995 and 2005 at Manchester Royal Eye Hospital n/a. ACORN index was used to measure socioeconomic status Patients in the socioeconomically deprived group presented with more advanced field loss, lower educational attainment (18 vs 98% with no or unknown qualification), and were less aware of glaucoma in the family (27 vs 17%) The extent of visual field loss in glaucoma patients at first presentation is related to a combination of clinical and socioeconomic factors including the patient's postcode: these findings could be used to target future case-finding resources Fit for purpose 49 patients were included in affluent group and 64 patients included in socioeconomically deprived group v1.1 Page 80 of 91 Swamy B, Cumming RG, Ivers R, Clemson L, Cullen J, Hayes MF, Tanzer M, Mitchell P. (2009). Vision screening for frail older people: a randomised trial. British Journal of Ophthalmology, 93(6): 736-741. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusion Quality A randomised trial assessing the effects of vision screening, and subsequent management of visual impairment, on visual acuity and vision-related quality of life among frail older people 616 men and women from a community in Sydney, Australia aged 70+ years recruited from outpatient aged care services Comprehensive vision and eye examinations conducted by an optometrist Distance and near visual acuity (logMAR) and composite scores on the 25-item version of the National Eye Institute Visual Function Questionnaire, both assessed at a 12month follow-up home visit There was no significant difference between the intervention and control group Vision screening by optometrist for frail older people living in the community does not lead to improvements in vision or visionrelated quality of life after 1 year Strong 300 participants received visual assessment while 316 participants formed the control group which received no vision assessment v1.1 Page 81 of 91 Swenor BK, Bressler S, Caulfield L, West SK (2010) The Impact of Fish and Shellfish Consumption on AgeRelated Macular Degeneration. Opthalmology, 13. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusion Quality A cross-sectional study of dietary and ophthalmologic data to determine the relationship between fish and shellfish consumption and age-related macular degeneration (AMD) status A random sample participants in the Salisbury Eye Evaluation Study (n = 2520) n/a Ophthalmic: status of AMD Weekly fish/shellfish consumption not different between specific AMD categories compared with controls These data support a protective effect of fish/shellfish intake against advanced AMD Fit for purpose Dietary: selfreported fish/shellfish consumption based on completion a food frequency questionnaire Association between weekly fish/shellfish intake and risk of AMD adjusting for risk factors and correlation between eyes v1.1 Those with advanced AMD significantly less likely to consume fish/shellfish high in omega-3 fatty acids (OR 0.4; CI 0.20.8) No relationship of AMD with intake of crab and oysters combined Page 82 of 91 Tan JSL, Wang JJ, Flood V, Mitchell P (2009) Dietary Fatty Acids and the 10-Year Incidence of Age-Related Macular Degeneration The Blue Mountains Eye Study. Arch Ophthalmol. 2009;127(5):656-665. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Population-based cohort study to assess the relationship between baseline dietary fatty acids and 10-year incident age-related macular degeneration (AMD) Patients aged 39 years of older living in a Australian town, diagnosed with AMD (n = 3654 at baseline; n = 2454 examined at 5 and/or 10 years later) n/a 145-item, semiquantitative food frequency questionnaire (FFQ) Adjusting for age, sex, and smoking, 1 serving of fish per week was associated with reduced risk of incident early AMD Regularly eating fish, greater consumption of -3 polyunsaturated fatty acids, and low intakes of foods rich in linoleic acid appear to protect against early AMD Strong Grading of AMD Intervieweradministered questionnaire on demographic information, family history, medication history, history of smoking and alcohol use Relative risk for specific outcomes v1.1 Two servings of nuts per week was associated with reduced risk of incident early AMD Regular consumption of nuts may also reduce AMD risk Joint effects from multiple factors are suggested Page 83 of 91 Taylor HR, Vu HTV, McCarty CA, Keefe, JE (2004) The Need for Routine Eye Examinations. Investigative Ophthalmology & Visual Science, 45(8). Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Prospective study to determine the incidence and causes of vision loss to assist in the objective determination of the preferred frequency of routine screening for those with normal vision People aged 40 years or more, living six months in Melbourne (n = 3271 eligible at baseline study; 2594 at five-year follow-up) n/a Ophthalmic assessment: presenting and best corrected visual acuity, visual field testing; comprehensive eye examination with dilation The 5-year incidence of vision loss was 2.39% Frequent routine eye examinations of those with normal results will have a low yield and may not be cost effective Strong Socioeconomic indicators: sociodemographic characteristics; history and current symptoms of eye disease; medical history; and medication use v1.1 Overall, 24 of those 38 people with vision loss had noticed a change in their vision, and 18 of 24 had attended an eye examination Only 14 people who had normal baseline examination results developed asymptomatic vision loss over the 5-year period Non-UK study Health promotion messages should target those who notice a change in vision and those at higher risk Page 84 of 91 Thornton J, Edwards R, Mitchell P, Harrison RA, Buchan I, Kelly SP. (2005) Smoking and age-related macular degeneration: a review of association. Eye, 19(9): 935-44. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Systematic review of the epidemiological evidence associating smoking with agerelated macular degeneration (AMD) Dependent upon original study included in the review n/a Relationship between tobacco smoking and AMD or age-related maculopathy (ARM). Included an estimate of the degree of association (odds ratio or relative risk) Thirteen studies found a statistically significant association between smoking and AMD Cigarette smoking is likely to have toxic effects on the retina Strong Total of 17 studies: seven crosssectional studies (n = 23,081); four prospective cohort studies (n = approx. 59,000; approx. numbers due to one study which reported results from two time points); six case–control studies (n = 6703) The outcome measure was the presence of ARM or AMD as defined by the investigators of each study v1.1 Increased risk of AMD of two- to three-fold in current-smokers compared with never-smokers Five studies found no association between smoking and AMD In spite of the evidence, there appears to be a lack of awareness about the risks of developing eye disease from smoking among both healthcare professionals and the general public Page 85 of 91 Tsai T, Robin AL, Smith 3rd JP (2007) An evaluation of how glaucoma patients use topical medications: a pilot study. Trans Am Ophthalmol Soc, 105:29-35. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Pilot study to evaluate how glaucoma patients use topical medications Patients attending regularly scheduled clinical visits with one of two geographically distinct glaucoma specialists (n = 253) n/a Questionnaire: current use of eye drops and administration techniques Approx 17% of participants relied on others for the administration of drops Fit for purpose Demographics: age, gender, selfreported ethnicity Inadequate vision and manual dexterity were leading causes of dependency Although most individuals may have little difficulty with the use, storage, and handling of eye drops, a broad variation in reported practices exists Only 16.3% of selfadministering used a mirror This finding suggests a need for better instruction in eye drop administration The most common location for administration was bedroom (46.8%), or bathroom (23.4%) v1.1 Page 86 of 91 Walker EA, Schechter CB, Caban A, Basch CE. (2008). Telephone intervention to promote diabetic retinopathy screening among the urban poor . Journal of Preventive Medicine. Vol. 34, pt. 3, pp. 185-91 Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality A randomised controlled trial testing the hypothesis that a tailored telephone intervention in urban minority diabetes populations, offered in English or Spanish, would result in greater screening for retinopathy than a standard print intervention 598 diabetic patients (40% male, mean age = 57 years) of three healthcare centres in the Bronx, NY. A tailored telephone intervention to promote retinopathy screening (intervention group) compared to a standard print intervention (control group) over a 6month period Documentation of a dilated fundus examination (DFE) within 6 months was the main outcome There was a 74% increase in retinopathy screening in the telephone (intervention group) versus print (control) group, with no differences by intervention language or by gender A limited telephone intervention can improve significantly participation in retinopathy screening in a minority, lowincome population Strong 45% of participants were African American and 42% of Hispanic ethnic origin with 23% choosing to receive the intervention in Spanish Data on risk perceptions using the Risk Perception Survey for Diabetes were collected preand postintervention Electronic databases were used to obtain hemoglobin A1c information v1.1 Subjects who had poor diabetes control responded with greater success to telephone interventions Non-UK study Further research is needed to develop effective risk communications to prevent the complications of diabetes Page 87 of 91 Wilson R, Walker A, Dueker DK, Pitts-Crick R. (1982) Risk factors for rate of progression of glaucomatous visual field loss. Archives of Ophthalmology 100: 737-742. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Study to examine factors affecting the progression of visual field loss caused by Glaucoma Patients with bilateral open angle glaucoma (n = 57) n/a Visual field loss at initial examination Patients with marked visual field loss at initial examination deteriorated 11.7 times faster than patients without initial field loss Visual field loss at follow-up Conclusions Quality Fit for purpose (but now rather dated: however, widely cited and not contradicted) Family history of glaucoma, gender, and initial registration intraocular pressure important prognostic factors for progressive visual field loss Age and systemic blood pressure not found to affect rate of visual field loss v1.1 Page 88 of 91 Wolfs RC, Klaver CC, Ramrattan RS, van Duijn CM, Hofman A, de Jong PT (1998) Genetic risk of primary openangle glaucoma: Population-based familial aggregation study. Arch Ophthalmol, 116(12): 1640-5. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Population based study to examine familial aggregation of primary open angle glaucoma in a general population and to determine the absolute and relative risks for first-degree relatives First-degree relatives of patients with glaucoma (n = 48) and control subjects (n = 155) from the population-based Rotterdam Study n/a Ophthalmic: intraocular pressure; vertical cup-disc ratio; and the presence of glaucoma Prevalence of glaucoma 10.4% in siblings of patients, 1.1% in offspring of patients, 0.7% in siblings of controls, 0% in offspring of controls Relatives of patients with glaucoma have a strongly increased risk of glaucoma Strong Other risk factors: presence of diabetes mellitus or hypertension Covariates: age and gender Risk ratio for glaucoma in relatives of patients vs. controls was 9.2 (95% CI = 1.2-73.9) Populationattributable risk of glaucoma 16.4% v1.1 Non -UK study Enlarged cup-disc ratio, not intraocular pressure, the earliest and most prominent feature of familial aggregation Further studies needed to disentangle genetic components of increased familial risk Page 89 of 91 Wormald RP, Basauri E, Wright LA, Evans JR (1994) The African Caribbean Eye Survey: risk factors for glaucoma in a sample of African Caribbean people living in London. Eye, 8(3): 315-20. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Cross-sectional study to estimate the prevalence of and risk factors for chronic glaucoma in a sample of African Caribbean people over 35 years African and Caribbean people living in the London borough of Haringey (n = 873) n/a Socio-economic: personal and family medical and ocular history, migration history; and demographic data 32 definite cases of glaucoma were identified, a prevalence of 3.9% Study provides strong evidence that the 4 times greater risk of glaucoma estimated for American blacks compared with whites applies equally to the United Kingdom population Fit for purpose Community-based survey clinics at six different sites in Haringey Blood pressure and blood sugar Ophthalmologic: binocular and uniocular visual acuity; suprathreshold visual fields, applanation tonometry, lens opacity; vertical cup-to-disc ratio; and fundus photography v1.1 Comparison with a previous study revealed a relative risk for glaucoma for Haringey blacks compared with Irish whites of 3.7 Significant risk factors for glaucoma included age, African birthplace and darker skin colour UK study Community-based facilities are required to raise awareness of the risk among this ethnic minority in this country and case finding resources should be provided Page 90 of 91 Zhang X, Norris SL, Saadine J, Chowdhury FM, Horsley T, Kanjilal S, et al. (2007) Effectiveness of interventions to promote screening for diabetic retinopathy. American Journal of Preventive Medicine, 33(4): 318-35. Study Purpose & Type Sample Characteristics Intervention Outcome Measures Results Conclusions Quality Systematic review to assess the effectiveness of interventions aimed to increase retinal screening among people with diabetes Dependent upon original study included in the review Patient focused: awareness of DR; adherence to recommendations Flexibility of providers and practices System-focused: access to health care; availability of a delivery system; better records; creation of a screening system; improved services in a resource-poor agency Primary measure: relative risk (RR) Four of five RCTs focusing on patients demonstrated interventions significantly increased screening Provider focused: adherence to recommendations reduced negligence of practices. Increasing patient knowledge of diabetic retinopathy, improving provider and practice performance, and improving healthcare system infrastructure and processes, can significantly increase screening for diabetic retinopathy Strong Interventions used to promote screening for diabetic retinopathy (DR) in any language and with any study design 12 randomized controlled trials (RCT); four nonrandomized studies; 32 pre–post studies (n = 162,157) Five RCTs with a focus on the system all demonstrated significant increases in screening Non-RCTs, which included also generally demonstrated positive effects v1.1 Page 91 of 91