Adrian R. Hill

Cataract surgery in patients with age-related macular degeneration One-year outcomes

Purpose: To determine whether patients with age‐related macular degeneration (ARMD) benefit from cataract surgery and to assess the risk of progression of preexisting maculopathy 4 and 12 months postoperatively. Setting: Princess Alexandra Eye Pavilion, Royal Infirmary of Edinburgh, Edinburgh, Scotland. Methods: Two groups of patients were evaluated prospectively. The study group comprised patients with ARMD scheduled to have cataract surgery (n = 40). The control group comprised patients with ARMD not having cataract surgery (n = 43). Patients were assessed at baseline (preoperatively) and 4 and 12 months postoperatively. Assessment included visual function tests and quality of life (QoL) measures. The mean values for each item tested were obtained for each group at each visit, and comparisons between visits were done using the Wilcoxon signed rank test. Results: There were significant benefits of cataract surgery in terms of visual function and QoL measures at 4 and 12 months. There was no increased risk of progression of maculopathy in the study group. There were no significant differences in the items tested in the control group. Conclusions: One year postoperatively, QoL benefits were maintained in the study group and there was no increased risk of progression of maculopathy in patients with mild and moderate degrees of ARMD. Larger numbers of patients must be assessed prospectively for longer periods to determine the relative risk of progression of different stages of ARMD after cataract surgery.

Patient satisfaction as an evaluation measure of low vision services

Estimates of patient satisfaction are increasingly used as an outcome measure in the evaluation of health care. However, surveys are based on untested and incorrect assumptions about what a patient is reporting. In this paper some of these general concerns are presented. This is followed by results from a study on satisfaction from 195 patlents attending a low vision service. Results indicate complex patterns of association with four different estimations of satisfaction from both visual and non-visual factors. Different combinations of visual and non-visual factors had different predictive values for the satisfaction scales. The results are in line with more general findings on satisfaction and suggest that satisfaction is a multi-faceted concept which may easily be misinterpreted in a typical satisfaction survey.

Information used in rehabilitation decisions: some research results

This paper describes the results of a research programme (1988-89) directed at determining what information is used by the staff in social services departments responsible for making decisions about the rehabilitation of visually handicapped people. Four principal categories of information were identified: personality and aptitude traits; level of social and financial support; general health (including age); and aspects of visual function. The first two sources of information accounted for 65% of discriminations made for alternative course of action in rehabilitation, while information about visual function was the least frequently used (i.e. 11%). There was no evidence that informa tion about a patient/clients clinical diagnosis was used in decision-making about rehabilitation. The results of this study were used to assist redrafting of the revised BD8 (1990) form.

Vision Welfare: Inter-Professional Co-operation or Fragmentation?

Often professional language and professional practices create communication barriers which adversely affect patient care in low vision services. The use of a common, non-technical information medium owned by the patient may be an effective way of holding relevant information for all professionals in a case.

Information Used in Rehabilitation Decisions Dear Editors

Dear Editors, We are grateful for the observations made by Bob Greenhalgh (BJVI, March 1993) on our paper ’Information used in rehabilitation decisions: some research results’ (BJVI, November 1992). There does appear to be a conflict between our findings and the beliefs of his colleagues that &dquo;information obtained from ophthalmologists and optometrists is essential in developing relevant plans for the management of visual impairment&dquo;. Of course, there are many instances in psychology of peoples’ espoused beliefs being at odds with their beliefs in action. Nonetheless, we wish to emphasise that the personal construct approach which we used in no way foreclosed the emergence of clinical information. Indeed, one of the claims made on its behalf is that it is a technique relatively free from interviewer bias so that the interviewee &dquo;tells it as it