G. Ratnarajan - Academia.edu (original) (raw)
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Papers by G. Ratnarajan
British Journal of Ophthalmology, Oct 30, 2012
Aim To investigate whether the publication of the National Institute for Health and Clinical Exce... more Aim To investigate whether the publication of the National Institute for Health and Clinical Excellence (NICE) glaucoma guidelines had an effect on the agreement of examination findings between professionals involved in an established glaucoma referral refinement pathway.
Methods To report inter-professional agreement for the clinical examination findings of optometrists with a special interest in glaucoma (OSI), optometrists with no specialist interest in glaucoma (non-OSI) and a glaucoma consultant. Part 1 investigated agreement between an OSI and consultant and part 2 investigated agreement of clinical findings between the non-OSI and a specialist clinician (OSI or consultant).
Results Part 1: Agreement between OSI and consultant in determining an abnormal intraocular pressure (IOP) (>21 mm Hg) expressed as a percentage positive predictive value (PPPV) was no different pre-NICE (60.6%) and post-NICE (61.4%, p=0.51) guidelines. PPPV for identification of an abnormal optic disc was better pre-NICE (60.6%) than post-NICE (42.7%, p=0.02). The appropriate referral rate for patients referred by an OSI was higher pre-NICE (69.6%) than post-NICE (61.2%) (p=0.07). Part 2: The PPPV between non-OSI and specialist clinician for an abnormal IOP was better pre-NICE (62.5%) than post-NICE (50.9%, p=0.12). This was also observed for abnormal optic discs, 70.0% pre-NICE and 52.9% post-NICE (p=0.04).
Conclusions The accuracy for detecting an abnormal IOP by the OSI has remained unchanged post-NICE, but there was a reduction in accuracy in detecting an abnormal optic disc as well as the appropriate referral rate. For the non-OSI, there was a decline in both IOP and optic disc assessment accuracy.
BMJ case reports, 2013
A 2-year-old girl presented to the emergency department at 3:00 h with severe pain in her right e... more A 2-year-old girl presented to the emergency department at 3:00 h with severe pain in her right eye and a rust coloured, blood stained frothy discharge that had woken her. An examination of her eye revealed a shiny metallic looking foreign body, which was immediately removed by the on-call ophthalmologist. That morning the patient underwent ocular examination under anaesthesia and was found to have severe tissue necrosis resulting from an electrochemical burn. She was treated with daily rodding for 3 days and betamethasone ointment four times a day, which was gradually tapered. At 3 months her only eye pathology was a mild symblepharon between the bulbar and tarsal conjunctiva. This is the first case of delayed symptoms after placement of a button battery into the conjunctival fornix. This case highlights the serious nature of button battery injuries to the eye and the potential to miss the diagnosis owing to a delayed onset of symptoms.
Perspectives in Public Health, 2012
Journal of Cataract & Refractive Surgery, 2011
There is a growing trend toward microincision cataract surgery (MICS) techniques with main incisi... more There is a growing trend toward microincision cataract surgery (MICS) techniques with main incision widths of around 2.0 mm. 1,2 Creating a good-quality continuous curvilinear capsulorhexis (CCC) through a small incision using traditional capsulorhexis forceps can be difficult, especially for trainee surgeons. We have found that when reaching across the far side of the anterior chamber, traditional base-hinged capsulorhexis forceps fit too tightly inside the main incision, reducing maneuverability and putting local stress on the wound, which can distort the corneal surface and reduce visualization. However, cross-action capsulorhexis forceps demonstrate excellent maneuverability in the anterior chamber because their pivot point sits within the wound.
British Journal of Ophthalmology, Oct 30, 2012
Aim To investigate whether the publication of the National Institute for Health and Clinical Exce... more Aim To investigate whether the publication of the National Institute for Health and Clinical Excellence (NICE) glaucoma guidelines had an effect on the agreement of examination findings between professionals involved in an established glaucoma referral refinement pathway.
Methods To report inter-professional agreement for the clinical examination findings of optometrists with a special interest in glaucoma (OSI), optometrists with no specialist interest in glaucoma (non-OSI) and a glaucoma consultant. Part 1 investigated agreement between an OSI and consultant and part 2 investigated agreement of clinical findings between the non-OSI and a specialist clinician (OSI or consultant).
Results Part 1: Agreement between OSI and consultant in determining an abnormal intraocular pressure (IOP) (>21 mm Hg) expressed as a percentage positive predictive value (PPPV) was no different pre-NICE (60.6%) and post-NICE (61.4%, p=0.51) guidelines. PPPV for identification of an abnormal optic disc was better pre-NICE (60.6%) than post-NICE (42.7%, p=0.02). The appropriate referral rate for patients referred by an OSI was higher pre-NICE (69.6%) than post-NICE (61.2%) (p=0.07). Part 2: The PPPV between non-OSI and specialist clinician for an abnormal IOP was better pre-NICE (62.5%) than post-NICE (50.9%, p=0.12). This was also observed for abnormal optic discs, 70.0% pre-NICE and 52.9% post-NICE (p=0.04).
Conclusions The accuracy for detecting an abnormal IOP by the OSI has remained unchanged post-NICE, but there was a reduction in accuracy in detecting an abnormal optic disc as well as the appropriate referral rate. For the non-OSI, there was a decline in both IOP and optic disc assessment accuracy.
BMJ case reports, 2013
A 2-year-old girl presented to the emergency department at 3:00 h with severe pain in her right e... more A 2-year-old girl presented to the emergency department at 3:00 h with severe pain in her right eye and a rust coloured, blood stained frothy discharge that had woken her. An examination of her eye revealed a shiny metallic looking foreign body, which was immediately removed by the on-call ophthalmologist. That morning the patient underwent ocular examination under anaesthesia and was found to have severe tissue necrosis resulting from an electrochemical burn. She was treated with daily rodding for 3 days and betamethasone ointment four times a day, which was gradually tapered. At 3 months her only eye pathology was a mild symblepharon between the bulbar and tarsal conjunctiva. This is the first case of delayed symptoms after placement of a button battery into the conjunctival fornix. This case highlights the serious nature of button battery injuries to the eye and the potential to miss the diagnosis owing to a delayed onset of symptoms.
Perspectives in Public Health, 2012
Journal of Cataract & Refractive Surgery, 2011
There is a growing trend toward microincision cataract surgery (MICS) techniques with main incisi... more There is a growing trend toward microincision cataract surgery (MICS) techniques with main incision widths of around 2.0 mm. 1,2 Creating a good-quality continuous curvilinear capsulorhexis (CCC) through a small incision using traditional capsulorhexis forceps can be difficult, especially for trainee surgeons. We have found that when reaching across the far side of the anterior chamber, traditional base-hinged capsulorhexis forceps fit too tightly inside the main incision, reducing maneuverability and putting local stress on the wound, which can distort the corneal surface and reduce visualization. However, cross-action capsulorhexis forceps demonstrate excellent maneuverability in the anterior chamber because their pivot point sits within the wound.