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Non‐surgical treatments for eyes with convergence insufficiency

Convergence insufficiency is a common eye muscle co‐ordination problem in which the eyes have a strong tendency to drift outward (exophoria) when reading or doing close work. This systematic review aimed to search for, assess, and synthesize evidence from randomized controlled trials (RCTs) on the effectiveness of non‐surgical interventions for convergence insufficiency.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Interventions for eye movement disorders in people with stroke

Eye movement disorders may affect over 70% of stroke patients and can make it difficult to keep both eyes in their normal position when looking straight ahead, or can make it difficult to move the eyes accurately to look in a different direction. This can affect patients' perception of depth, makes it difficult for them to take in their whole surroundings and can severely affect the ability to read. We found only two randomised controlled trials which investigated treatments for eye movement disorders. Both of these studies investigated the effect of drug treatments. A total of 28 participants were included but only five of these were people with stroke. One study found that the people with stroke responded differently to the drug treatment than people who had eye movement disorders due to other conditions. These studies provide too little evidence from which to reach any conclusions about the effectiveness of interventions for patients with eye movement disorders after stroke. Further research is urgently required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Adjustable versus non‐adjustable sutures for the eye muscles in strabismus surgery

Strabismus occurs when the eye deviates from its normally perfect alignment, and can be corrected with surgery. A variety of surgical techniques are available, including the use of adjustable or non‐adjustable sutures for the muscles surrounding the eye. There is uncertainty as to which of these suture techniques results in a more accurate alignment of the eye, and whether there are specific situations in which it is of benefit to use a particular technique. This review could not find enough evidence to answer these questions and suggests that more research is needed. The review authors used existing evidence to propose that future randomised controlled trials should directly compare the adjustable to the non‐adjustable suture technique, in co‐operative patients with any type of strabismus. Trials should have a minimum of six months follow‐up and should include important outcome measures such as re‐operation rates, accuracy of ocular alignment, complications, economics and patient satisfaction. The information generated from well‐designed studies could support a change in the conventional surgical management of strabismus and help to direct planning of surgical training.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Treatment of amblyopia (lazy eye) caused by strabismus (squint) with patching or optical treatment (glasses or penalisation) or both

Review question: Treatment of amblyopia (lazy eye) caused by strabismus (squint) with patching or optical treatment (glasses or penalisation) or both.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Different treatments for a squint (deviation of the eye) that occurs within the first six months of life

Infantile esotropia can affect the vision in the eye, the ability to use the two eyes together (binocularity) and also be a cosmetic issue to the child/parents. Treatment includes surgical and non‐surgical interventions to reduce the squint and to enhance/aid binocularity in children. This review looks at the various interventions and also the timing of such treatment. The review did not find any randomised trials that compared treatment to another treatment or to no treatment. A large, multi‐centre, non‐randomised trial found that children operated on earlier had better binocularity at age six compared to the late surgery group. This group had been operated on more frequently however and there was no significant difference in the angle of the squint after surgery in either group. This review does not resolve the controversy regarding the best type of surgery, the value of non‐surgical interventions and the optimal timing of either type of intervention. It highlights a need for further research in this area.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Treatment for a type of childhood strabismus where one or both eyes intermittently turn outwards

Strabismus is a condition in which the eyes are not normally aligned, that is one eye looks straight ahead whilst the other eye turns inwards, outwards, up or down. Most cases of childhood onset strabismus are present constantly, but some types are intermittent that is only present sometimes. In intermittent exotropia (X(T)) an eye intermittently turns outwards (exotropia), typically more when looking into the distance, when tired or day‐dreaming. When the child focuses on something close, the eye usually moves back to the centre. The eyes typically work together normally when the exotropia is controlled. When the exotropia occurs, the image from one eye is usually switched off or 'suppressed'. Treatment for X(T) may be sought to improve the appearance of misalignment or if there is concern that it is affecting the ability of the eyes to work together. Treatment typically consists of surgery on the muscles around the eye, either on the outside muscle of both eyes or on the inside and outside muscle of one eye. Exercises to strengthen the muscles may sometimes be used; sometimes patching or glasses for short or near sightedness can be tried. There is currently not a clear understanding of which treatments work most effectively and at what point any treatment should be given. We searched for studies where participants with X(T) had been randomised to receive treatment. The aim was to understand which treatments are most effective at correcting the exotropia without causing any harm. The one study included in this review was conducted by a single surgeon in the USA and compared surgery on one eye to surgery on both eyes in 36 children with the basic type of X(T). Success was defined as no exotropia (or other strabismus) one year following surgery. The study found that surgery on one eye was more effective (82% success) than surgery on both eyes (52% success). There are many studies of X(T) in the current literature but the methods used make it difficult to reliably interpret the results. Furthermore, there is a worrying lack of evidence regarding the natural history of X(T) and poor validation of measures of severity. There is a clear need for further randomised studies to provide more reliable evidence for the management of this condition.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Botulinum toxin for the treatment of strabismus

The aim of this Cochrane Review was to find out how well botulinum toxin works as a treatment for strabismus. Cochrane researchers collected and analysed all relevant studies to answer this question and included six studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Surveillance for Ocular Hypertension: An Evidence Synthesis and Economic Evaluation

To determine effective and efficient monitoring criteria for ocular hypertension [raised intraocular pressure (IOP)] through (i) identification and validation of glaucoma risk prediction models; and (ii) development of models to determine optimal surveillance pathways.

Health Technology Assessment - NIHR Journals Library.

Version: June 2012
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Menopause: Full Guideline

In summary, a large number of women in the UK experience menopausal symptoms which, in many cases, can significantly affect their quality of life. It is probable that a minority of these women seek medical treatment and for those who do there is considerable variation in the help available, with many being told that the symptoms will get better with time. Since symptoms may often continue for 7 years or more, this advice is inappropriate and help should be offered where possible. Women need to know about the available options and their risks and benefits, and be empowered to become part of the decision-making process.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: November 12, 2015

Visual Dysfunction in Patients with Traumatic Brain Injury: A Systematic Review [Internet]

In 2009, approximately 3.5 million people sought treatment related to a traumatic brain injury (TBI) in the United States (U.S.), just over 1% of the U.S. population. Researchers estimate that approximately 15% of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) U.S. Service Members have incurred TBI during deployment. This equates to 390,000 of the 2.6 million Service Members who have deployed as of 2014. Given that intact visual functioning depends on portions of the brain interacting in complex ways, there are multiple potential mechanisms through which TBI can result in visual dysfunction. To provide relevant data for policymakers, optometrists, ophthalmologists, rehabilitation specialists, and others who provide services for Veterans with TBI history, we conducted a systematic review of the prevalence and types of visual dysfunction in individuals with a history of TBI.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: September 2014
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Treatment of accommodative and nonstrabismic binocular dysfunctions: a systematic review

The review found evidence that vision therapy was effective for treatment of convergence insufficiency, but that pencil push-up and base-in prism therapy were not effective. There was insufficient evidence to support specific therapeutic options for other non-strabismic binocular anomalies or accommodative disorders. In view of the suboptimal search and small amount of randomised data, the authors’ conclusions require cautious interpretation.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Diagnosis and Management of Infantile Hemangioma [Internet]

To systematically review evidence addressing the diagnosis and management of infantile hemangiomas (IH).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: January 2016
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Interventions to Prevent Falls in Older Adults: An Updated Systematic Review [Internet]

Falls represent an important source of preventable morbidity and mortality in older adults, the fastest growing segment of the U.S. population. We undertook a systematic review of falls interventions applicable to primary care populations to inform the U.S. Preventive Services Task Force’s (USPSTF’s) updated recommendation on preventing falls in older adults.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: December 2010
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Screening for Visual Impairment in Children Ages 1-5 Years: Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation [Internet]

Impaired visual acuity is common in preschool-aged children. Screening for impaired visual acuity in primary care settings could identify children with vision problems at a critical period of visual development and lead to interventions to improve vision, function, and quality of life.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: February 2011
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Multiple Sclerosis: Management of Multiple Sclerosis in Primary and Secondary Care

Multiple sclerosis (MS) is an acquired chronic immune-mediated inflammatory condition of the central nervous system (CNS), affecting both the brain and spinal cord. It affects approximately 100,000 people in the UK. It is the commonest cause of serious physical disability in adults of working age.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: October 2014
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Type 1 Diabetes in Adults: Diagnosis and Management

Type 1 diabetes affects over 370,000 adults in the UK, representing approximately 10% of adults diagnosed with diabetes. Given the complexity of its treatment regimens, successful outcomes depend, perhaps more than with any other long-term condition, on full engagement of the adult with type 1 diabetes in life-long day-by-day self-management. In order to support this, the health service needs to provide informed, expert support, education and training as well as a range of other more conventional biomedical services and interventionsfor the prevention and management of long term complications and disability.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: August 2015
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Interventions for Atypical Facial Pain: A Review of Clinical Effectiveness and Guidelines [Internet]

The purpose of this report is to review the available published literature relating to pharmacological and non-pharmacological interventions for the treatment of atypical facial pain (AFP) in adults.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: April 1, 2016
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Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version

Expert-reviewed information summary about the health problems that appear after cancer treatment has ended.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 14, 2017

Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital

Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

NICE Clinical Guidelines - National Clinical Guideline Centre – Acute and Chronic Conditions (UK).

Version: 2010

Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral fractures: a systematic review and cost-effectiveness analysis

Study found that for people with painful osteoporotic vertebral compression fractures refractory to analgesic treatment, percutaneous vertebroplasty and balloon kyphoplasty significantly reduce pain and improve quality of life compared with optimal pain management. However, there is no evidence that either performs better than operative placebo with local anaesthetic. Complications from either procedure are rare but can be serious. Further research is needed to establish whether or not either procedure has a mortality advantage over or utility gain compared with operative placebo with local anaesthetic.

Health Technology Assessment - NIHR Journals Library.

Version: March 2014

Systematic Reviews in PubMed

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