Preoperative and perioperative music to reduce anxiety during first-time phacoemulsification cataract surgery in the high-volume setting: randomized controlled trial.
Journal of cataract and refractive surgery
PURPOSE: To determine if preoperative and perioperative music exposure reduced patient self-rated anxiety and physiologic indicators of stress during first-time phacoemulsification cataract surgery in the high-volume setting.SETTING: Aravind Eye Care System, Pondicherry, India.DESIGN: Prospective single-masked randomized controlled trial.METHODS: Patients were provided music before and during first-time phacoemulsification in one group and patients underwent surgery without music in another group. Measurements of blood pressure, heart rate, respiration rate, and a Likert-scale anxiety rating were collected at preoperative, perioperative, and postoperative time points.RESULTS: 165 patients (aged 53-65) were provided music via a portable MP3 player before and during first-time phacoemulsification, and 165 patients underwent surgery without music. Systolic and diastolic blood pressures were significantly lower in the music intervention group at the postoperative time point, with similar physiologic measures between groups during the perioperative time points. In the preoperative period before music exposure, 62 patients (38%) in the music group reported being very or extremely anxious. After 10 minutes of music exposure, only 7 patients (4%) reported this anxiety level. In the perioperative period, 80 patients (48%) in the intervention group reported feeling not at all or a little anxious, compared to 50 patients (30%) of the control group. In the postoperative period, 139 (84%) music group patients felt not at all or a little anxious after surgery compared with 92 patients (56%) in the control group.CONCLUSION: Marked reductions in self-reported anxiety before, during, and after surgery when exposed to music and a significant decrease in postoperative blood pressure showed music can be an inexpensive and effective solution to improve the patient experience of cataract surgery in the high-volume setting.
View details for DOI 10.1097/j.jcrs.0000000000000485
View details for PubMedID 33196574
Diagnostic challenges in a case of an isolated third nerve palsy.
American journal of ophthalmology case reports
2020; 18: 100585
Neuro-ophthalmic manifestations may be the first and sole presenting feature of a nasopharyngeal carcinoma. Peri-neural spread is an emerging phenomenon that explains the distant spread of tumour cells well beyond the local extent of invasion. This under recognized route of tumour spread often results in delayed diagnosis and reduced life expectancy. The authors report a case of an isolated third nerve palsy as the only initial manifestation of nasopharyngeal carcinoma and emphasize the need for a high index of suspicion.The patient presented with left painful pupil involving complete third nerve palsy. Contrast enhanced imaging was initially deferred due to renal impairment. Plain MRI with MRA brain was normal. Hematology was suggestive of giant cell arteritis which is a rare but well documented cause of painful nerve palsies in the elderly. Unresponsiveness to steroids prompted contrast imaging with a reduced gadolinium dosing and hemodialysis backup which finally revealed a nasopharyngeal carcinoma.This report is the journey of a third nerve palsy from a clinical diagnosis of an aneurysm (pupil involving palsy) to a probable diagnosis of giant cell arteritis (based on hematology) and to a final diagnosis of nasopharyngeal carcinoma (based on contrast imaging and immunohistochemistry)Nasopharyngeal carcinoma can be successfully cured if detected early. This report highlights the various manifestations of nasopharyngeal carcinoma and challenges faced in diagnosing this elusive tumor.
View details for DOI 10.1016/j.ajoc.2020.100585
View details for PubMedID 32099933
View details for PubMedCentralID PMC7031130
Knowledge, attitude and practise toward COVID-19 among patients presenting to five tertiary eye care hospitals in South India - A multicentre questionnaire-based survey.
Indian journal of ophthalmology
2020; 68 (11): 2385–90
The aim of this study was to assess the knowledge, attitude, and practice (KAP) pattern towards COVID-19, among patients presenting to eye care hospitals during the last phase of lockdown period.A multicenter cross-sectional survey was conducted from May 15 to June 15, 2020 in five tertiary eye care hospitals in South India to assess the KAP towards COVID-19. Each of the hospitals belonged to one of the three different zones assigned in India based on number of infections. Red zones represent hotspots and orange/green zones represent regions with medium and lower caseloads, respectively. A validated questionnaire was administered through telephone and responses were recorded on a Google form.Out of the total (n = 6119) participants, 3081 were from hospitals in green zone, 2110 from the orange zone, and 928 from red zone. Majority of participants were above 50 years of age (42%) and 15.54% were illiterate. The mean (percentage) scores of knowledge, attitude, and practice were 21.26 (82%), 9.37 (92%), and 10.32 (86%), respectively. KAP among patients more than 50 years of age and in illiterate individuals was significantly less (P < 0.01) when compared with all other groups. Participants from red zone had a significantly better attitude (P < 0.01) compared to other centers.Although the overall KAP regarding COVID-19 disease was robust (above 80% in all categories) in our participants, the high risk elderly population (>50 years) and illiterate individuals had a significantly lower KAP. These are populations in which education should be emphasized and appropriately delivered as a way to reduce COVID-19 risk.
View details for DOI 10.4103/ijo.IJO_2522_20
View details for PubMedID 33120624
Artificial Intelligence in Global Ophthalmology: Using Machine Learning to Improve Cataract Surgery Outcomes at Ethiopian Outreaches.
Journal of cataract and refractive surgery
Differences between target and implanted intraocular lens (IOL) power in Ethiopian cataract outreach campaigns were evaluated and machine learning (ML) applied to optimize IOL inventory and minimize avoidable refractive error. Patients from Ethiopian cataract campaigns with available target and implanted IOL records were identified and the diopter difference between the two measured. A gradient descent (an ML algorithm) was used to generate an optimal IOL inventory and measured the model's performance across varying surplus levels.Only 45.6% of patients received their target IOL power and 23.6% received underpowered IOLs with current inventory (50% surplus). The ML-generated IOL inventory ensured that >99.5% of patients received their target IOL when using only 39% IOL surplus.In Ethiopian cataract campaigns, the majority of patients have avoidable postoperative refractive error secondary to suboptimal IOL inventory. Optimizing IOL inventory using our ML model might eliminate refractive error from insufficient inventory and reduce costs.
View details for DOI 10.1097/j.jcrs.0000000000000407
View details for PubMedID 32932371