From table 2, it explains that the characteristics of research subjects aged 46-55 years with control patients as many as 7 people (46.7%), subjects with < 5 years diabetes mellitus as many as 4 people (26.7%), subjects with diabetes mellitus > 5 years as many as 3 people (20.0%) with a total subject of 14 people (100%). Research subjects aged 56-65 years with control patients as many as 4 people (26.7%), subjects with <5 years diabetes mellitus as many as 6 people (40.0%), subjects with diabetes mellitus > 5 years as many as 6 people (40.0%) with total subjects 16 people (100%). Research subjects aged > 65 years with control patients as many as 4 people (26.7%), subjects with < 5 years diabetes mellitus as many as 5 people (33.3%), subjects with diabetes mellitus> 5 years as many as 6 people (40.0%) with a total subject 15 people (100%). The Chi-Square Test results obtained p value 0.599 which showed no relationship between age and characteristics of the research subjects (p value> 0.05). This study is in line with the study of Abbas Azimi (2010) et al. That there were no statistically significant differences between age in the control group, < 5 years of diabetes mellitus patients and > 5 years of mellitus patients. 9
present a series of black-on-white letters in different sizes with the same contrast against the background. However, VA evaluation alone may be inadequate as the real world consists of not only black and white, but also shades of gray where images blend in with backgrounds. In comparison, contrastsensitivity (CS) determines the smallest amount of contrast required to be able to see a target. It defines the threshold between the visible and invisible. In this case, contrast is not kept constant during the test but is varied so that the minimum level of contrast for seeing a target can be determined. 21 CS is a fundamental aspect of visual perfor-
Other studies have shown that improvements in anatomic parameters and stable or moderately improved VA outcomes may be attained in treatment-resistant neovascular AMD patients switched to intravitreal aflibercept from another anti-VEGF agent. Results of this prospective, interventional investigation reveal a statistically significant improvement in CS and a statistically significant reduction in CRT over 12 weeks after treatment switch to aflibercept from ranibi- zumab in recalcitrant neovascular AMD patients, with no meaningful change from baseline VA observed. In our study series, a demonstrated correlation was observed between CRT decrease and improvement in Pelli–Robson log CS score at 12 weeks after treatment switch to aflibercept. Vision functioning, assessed using the NEI VFQ-25 score, improved from baseline to week 12 in two-thirds of the anti-VEGF switch population.
This retrospective analysis comprised 18 patients (19 eyes) aged 65–81 years (mean = 72.9; SD = 4.7), includ- ing 11 females and 7 males with EX-PRESS (Alcon, Novartis AG, Basel, Switzerland) shunt implanted through- out 2013–2014 in St Barbara Regional Specialist Hospital in Sosnowiec. The research was approved by the Research Ethics Committee of the Silesian Medical Chamber in Katowice (resolution number S´IL/KB/100p/17). Patient consent to review their medical records was not required by the bioethical committee due to the retrospective nature of this study and because patients’ information was suf- ficiently anonymized. All patients had secondary glaucoma and long-term and poorly controlled diabetes. The test group included 1 patient with type 1 diabetes and 17 patients with type 2 diabetes. The patients had earlier undergone full 23G PPV for diabetic complications, such as vitreoretinal pro- liferation with hemorrhage into the vitreous body chamber (15 patients) and traction retinal detachment (4 patients). A total of 9 eyes with NVG and 10 eyes with non-NVG were included. A topical antiglaucoma treatment did not bring in any effects in all patients. Secondary non-NVG occurred after hemorrhage due to diabetic retinopathy or after PPV with silicone oil endotamponade.
Although contrastsensitivity measurements have been recognized to be a more sensitive method for following patients with retinitis pigmentosa, there are several difficulties that need to be overcome for its routine use in the outpatient clinic. First, most of the contrastsensitivity measurements are performed with printed charts which are difficult to print with accurate contrast. Second, patients can remember the orientation of the gratings or the position of the letter on a printed chart. And third, accurate and consistent luminance changes are not fully achieved with slide projectors.
tion, such as prematurity, children with Down syndrome and developmental delay, and children with ocular conditions such as primary congenital glaucoma, optic pathway gliomas and optic neuritis. The range of functional deficits that accompanies paediatric ocular disease requires assessments for full evaluation of visual function in addition to standard VA tests. However, reliable assessments for currently existing CS tests suitable for paediatric use are limited. A new paediatric CS test may be of clinical value. The test should be able to provide an accurate measure of functional vision in children with and without a visual impairment. Such a test will allow clinicians to establish an individual’s functional level of vision and aid with rehabilitative strategies if required.
of the retinal nerve fiber layer (RNFL) . Our data showed that CS in both eyes were significantly correlated with the Rasch-calibrated NEI VFQ and GQL scores. At the same time, similar as VA, CS in the WE had weaker associations with Rasch-calibrated NEI VFQ and GQL scores compared with the BE. These results aslo imply there is a better correlation between the BE and QoL when the clinical parameter is mainly for evaluation of central visual function. Recently, a novel computer-based CS test, the Spaeth/Richman ContrastSensitivity Test (SPARCS), which is designed to evaluate both central and peripheral vision, was invented to more reliably identify the patients with glaucoma via the internet . Interestingly, Ekici et al. reported that the SPARCS had stronger correlations with the BE subscores . These results suggest that the central CS take the major role in the QoL. On the other hand, it is worth mentioning that the reduction of CS in the WE may cause abnormal binocular interaction due to imbalance of visual input from the two eyes which will seriously interfere with patient’ s daily living, just as the state of monocular amblyopia.
About 10% of diabeticpatients experience persistent pain.(44) Pain in DN can be spontaneous or stimulus induced, severe or intractable. DN pain is typically worse at night and can be described as burning, pins and needles, shooting, aching, jabbing, sharp, cramping, tingling, cold, or allodynia. Some patients develop predominantly small fiber neuropathy manifesting with pain and paresthesia early in the course of diabetes that may be associated with insulin therapy (insulin neuritis).(45) It is of less than six months duration, symptoms are aggravated at night, and manifest more in feet than hands. Sometimes acute DN pain is associated with weight loss and depression and has been termed as diabetic neuropathic cachexia.(46) This syndrome commonly occurs in men, and can occur at any time in the course of both type I and type II diabetes. It is self limiting and responds to symptomatic treatment. In these patients amyloidosis, heavy metal toxicity, Fabry’s disease, and HIV
The CSF is related to age, and aging can cause the onset of degenerative eye diseases. This study did not verify any interaction between these factors that could contribute to a limitation in the analysis and interpret- ation of the data. Considering the limiting effects that some age-related eye diseases pose to patients in their daily activities, future research aiming to analyze the im- pact of stroke in patients with cataracts, glaucoma and macular degeneration, for example, may contribute to the development of effective therapeutic measures. Fol- lowing stroke, the importance of ophthalmic evaluation should be considered during routine care of these patients to prevent complications and reduce the degree of disability.
Improvement in visual acuity and contrastsensitivity are the main aims for successful YAG laser posterior capsulotomy. Previous reports have focused primarily on visual acuity improvement after Nd:YAG laser as the main outcome measure. But this is inadequate to assess visual function which necessitates evaluation of contrastsensitivity 57 . In our study,
Patients and Methods: This was a non-interventional two-arm comparative study of visual outcomes after uncomplicated bilateral cataract or refractive lens exchange surgery with IOL implantation between 6 months and 5 years before a single diagnostic examination visit. There was no masking and no control group. Subjects had to have uncorrected distance visual acuity (UDVA) of 20/40 (0.3 logMAR) or better measured at the time of their study visit. Clinical evaluations included the manifest refraction, visual acuity (VA) at distance, intermediate (60 cm) and near (40 cm), low contrast (10%) VA and contrastsensitivity. Results: A total of 50 bilaterally implanted patients (25 trifocal, 25 EDOF) were examined; the two groups had similar characteristics, including corneal astigmatism. Postoperative refractive outcomes were also similar. There were no statistically signi ﬁ cant differences in distance or intermediate VA between groups, but the trifocal group had signi ﬁ cantly better near VA both uncorrected (p = 0.009) and distance-corrected (p = 0.014). There were no statistically signi ﬁ cant differences in the low contrast acuity measures between IOLs at either distance or 40 cm, with or without glare. Contrastsensitivity in mesopic and photopic conditions was similar.
Health workers in health institutions should identify patients ’ self-care demands and address patient needs by using a compressive care plan that includes a patient- centered approach to attain good glycemic control and improve treatment adherence. As this research ﬁ nally shows, most of the determinants will not be determinants once again if the patient ’ s potential for preventing diabetic complications is maximized. Successful diabetes care requires a systematic approach to support patients ’ behavior change efforts, so clinicians and health-care teams should take responsibility and make efforts to change patient beha- vior. Health-care providers also need to be responsible for undertaking the regular evaluation of barriers to treatment outcomes, if patients are not meeting the desired level of
Newer studies are in favour of lens implantation in diabetic eyes, as correction of aphakia with spectacle causes further image distortion and constriction of peripheral visual fields . The need for this study is to establish the influence of glycaemic control on visual control to better advice patients before surgery. The aim of this study was evaluation and comparison of visual outcomes after cataract surgery in diabetic and non-diabeticpatients: patients with and without diabetic retinopathy; assessment of post-operative complications after cataract surgery in diabetics compared to non- diabetics; and analysis of increment in central foveal thickness using optical coherence tomography, after cataract surgery. Also, through this study, we wanted to determine whether uneventful SICS/phacoemulsification cataract surgery led to adverse visual outcomes in diabetics.
Three months after the last laser session participants were administered a structured questionnaire in the vernacular language regarding their visual disabilities before and after laser treatment. The questionnaire was administered by a single trained interviewer who was blind folded regarding the BCVA and CS of the participants. Questions mentioned in the questionnaire were adapted from NEI VFQ-25 (National Eye Institute, Visual Function Questionnaire (25 Item)) and VDQ (visual disability questionnaire). VFQ-25 was selected because of the scale being able to compare the relative burden of visual disorders on the same scale which is designed to capture the impact of visual problems on physical functioning, emotional wellbeing and social functioning. The rigorous multi-condition evaluation of the scale proved it to be reliable and valid. 13 VDQ has been designed in India by Marella et al. 14 keeping in mind the Indian population and the difficulties they face in their daily activities. Activities like self grooming which was given maximum importance by the participants with visual disabilities have been incorporated in our questionnaire. The response from participants was recorded as worsening, improvement or no change as compared to the discomfort in these activities prior to laser treatment.
Non-ophthalmic doctors can have a retinopathy detection rate of 49% compared to 96% for ophthalmologists . Therefore, a cost effective method for screening is essential for diabetic retinopathy. Screening by digital photography proposed under the National Service Framework is offered to all patients with diabetes in the United King- dom. It is supplemented by biomicroscopy by the oph- thalmologists in monitoring and treating sight threatening disease. Furthermore, optical coherence tom- ography has become a powerful tool in screening and monitoring CSMO with sensitivity and specificity rates of near 80% and 90%, respectively . Perhaps with fur- ther investigation, TCCT testing may become a supple- ment for detecting and monitoring sight threatening pathology without much equipment or trained techni- cians. However, with current data, all forms of TCCT test- ing including the Chromatest do not qualify for use in screening for CSMO.
Contrastsensitivity determines how well a person sees faces in a crowd, read a newspaper or drives an automobile at night. These are questions pertaining to person’s quality of life and quality of vision. To obtain answers to these questions we need to assess the person’s functional vision. The conventional measurement of visual function like snellen’s acuity, colour vision and visual fields do not provide us with a complete picture of patient’s quality of vision. Snellen’s acuity is measure of resolution, the smallest size black on white letters a person can read. But objects in the real world come with a wide a range of contrast. 6
Many conditions (age, myopia, etc.) and eye diseases (diabetes, cataract, glaucoma, etc.) affect CS, just before any change in V.A. is detected. Studies around the world have been conducted by various researchers on CS changes depending on the case and the effect this change has on patients’ daily lives. With age, the functions of the body begin to decline and so does CS. Although it has generally not been established by studies in patients with good visual acuity, what exactly neurological changes in age contribute to the loss of CS.The frequencies initially affected are the lowest and begin at approximately after the age of 40 . Although myopia is a refractive error, it is a significant factor in effecting CS of the eye. Several studies show that there is a decrease in CSF in myopia, but the role of refractive error is unclear, as various optical factors, such as eye aberration (spherical aberration, diffusion by the crystalline lens), are inserted [23-25].The retina and the macula area are affected by several diseases, such as age-related macular degeneration, diabetes, detachment, central serous retinopathy, macular holes, etc. CS appears weakened to a degree regarding the severity of the disease [26-30]. For example, in the case of macular holes, the less tissue missing, the closer the CS is to the normal (but not completely normal) .Nevertheless, CS is definitely affected and usually before V.A. of the patient, in the early stages of the disease (age-related macular degeneration, diabetic retinopathy), causing problems in his quality of the patient life (driving, working etc.) [27,31,32]. In the retinal diseases category there are also studies with positive CS results. In some situation it is possible to recover part of the lost CS by restoring the tissue, such as retinal detachment, following surgery  or in cases of diabetic macular edema resection [6,32].
Summary: Purpose: To confirm the influence of multilevel metabolic disturbance of insulin dependent diabetes melli- tus (IDDM) on the vision even before the onset of the other changes routinely evaluated by ophthalmologists. Methods: Contrastsensitivity functions (CSFs) were estimated using the VCTS 6500 board. The standardised measurement pro- cedure was performed. The value of the threshold contrastsensitivity was obtained for five spatial frequencies (1.5 - 3 - 6 - 12 - 18 c/deg). Other data was collected (duration of diabetes, BCVA, funduscopy, fluoresceine angiography, HbA1C). The study group consisted of 48 IDDM patients (94 eyes) without diabetic retinopathy and with Snellen BCVA > 1.0. The control group (56 normals, 98 eyes) was age and BCVA matched. Results: Highly statistically signifi- cant decrease of the CSFs in all spatial frequencies in the study group was obtained. Correlation between duration of the diabetes and impaired degree of CSFs was present in the middle spatial frequency. No significant changes in CSFs were found among patients with pathological value of glycated hemoglobin HbA1c (> 7,8 %). Conclusions: If com- pared with routinely used Snellen visual acuity, the CSFs are more complex descriptors of the subjects vision abilities. IDDM has an influence on these sensitive functions, especially during examination in the middle spatial frequency of 6 and 12 c/deg, before disturbing visual acuity and before changes in the retinal morphology. Decrease of CSFs was influenced mainly by the patients’ age and partially (in the middle spatial frequency) by the IDDM duration.
Community Acquired Pneumonia (CAP) is defined as an acute infection of the pulmonary parenchyma in a patient who has acquired the infection in the community, as distinguished from hospital acquired (nosocomial) pneumonia (HAP). [6,7] The study is conducted to analyse the sputum bacteriology and antibiotic sensitivity pattern in patients having community acquired pneumonia. When the culture report is obtained, the treatment has to be changed according to the isolated organism. Methods: A Prospective observational study was conducted among patients admitted to the pulmonology, paediatrics and general medicine department of a teritiary care hospital. Patients who met the inclusion criteria were enrolled. Informed consent forms were taken from every patient after the procedure is being explained. The individual bacterial isolates and their sensitivity pattern to various antibiotics were also recorded. The result was later analysed, documented and then presented. Result: About 54.08% of cultures were positive for pathogenic bacteria. Among the pathogenic bacterial growth there are, 5 types of bacterial strain, out of which 3 were Gram negative bacteria 60% and 2 were gram positive bacteria 40%. The most common pathogenic bacteria isolated in sputum culture was Klebsiella pneumoniae followed by Staphylococcus aureus, Streptococcus pneumonia, Pseudomonas aeruginosa, Haemophilus influenza.
In our contrast method, injection of contrast material is followed by a saline flush to ensure efficient use of the contrast material [15,16]. Without a saline flush, a frac- tion of contrast material is retained in the injection route and the venous system from the upper extremity to the superior vena cava, and this fraction does not contribute to intended contrast enhancement. The volume of retain- ed agent is assumed to be similar irrespective of the con- centrations of contrast material. Therefore, the amount of iodine retained would be larger for a higher concentra- tion agent, and the amount of iodine that contributes to effective contrast enhancement would be larger for a lower concentration agent. A saline flush is not always performed for contrast injection in CT. The present study indicated a comparable contrast effect for high and me- dium concentrations of contrast materials with the use of a saline flush, which may suggest the superiority of a medium concentration agent.