OPT 211 Ocular Anatomy And Physiology

The article successfully addresses a clearly focused question that deals with the diagnosis, pathophysiology and the treatment of the condition that the given paper discusses about. The paper highlights the topic Idiopathic vitreomacular traction and macular hole. The authors have used paper that deals with the pathophysiology of vitreomacular traction and macular hole along with the papers that discussed the assessments techniques and the diagnosis of the symptoms that are presented for the condition being discussed in the paper.

The authors of the paper also was successful in establishing the symptomatic vitreomacular adhesions exert a tractional force on the macula which is the vitreomacular traction or VMT [1]. The papers used showed that VMT is associated with the formation of the epiretinal membrane along with the development of the holes in the macular.

The important outcomes which were derived from the article was that the pathologies behind the occurrence of this disorder. These pathophysiology had an impact on the visual acuity of the individuals. The article successfully showed the implementation of the technologies such as the optical coherence tomography that helped in increasing the accuracy of the vision in terms of macular anatomy [3]. This included characterization and the quantification of the macular hole. Another important outcome derived from the article was that the primary treatment opinion was the pars plana vitrectomy in case of patient suffering from VMT or IMH. It also showed that the development of a system of transconjunctival vitrectomy using narrow gauge can be helpful in improving the rate of the visual recovery. Ocriplasmin, by a process of degradation of laminin and fibronectin at the interface of the vitreoretinal interface, allows the induction of PVD in a manner that is non-invasive [2]. However the article presents that the can be applicable only to certain patient populations and not in all circumstances. This is seen in cases were the evidenced obtained from the article were applied in the clinical studies.

The paper mentions that there are no existing guidelines for the purpose of managing VMT. However the paper presents certain recommendations regarding. The recommendations include that the patients should be under observation for 2–3 months in order to observe spontaneous resolution occurs [5]. Although such is dependent on the severity of the symptoms and the impact it has on the individual patient’s quality of life.

The benefits of the paper are worth the harms and costs since the clinical studies have supported the evidences depicted in the paper. However there is a scope of the better understanding of the idea represented by conducting more research on this topic in future.The benefits of the paper also incudes that the patient groups which are defined in terms of the response rates to ocriplasmin that are most favourable [4]. These are the key priorities as well as it includes the timing of the intervention during the course of the disease. The potential benefits of ocriplasmin that are involved in inducing the separation of the vitreous separation with a clean ILM surface. Another possible benefit of vitreous separation that is presented in the early course of the disease along with the number of conditions that includes the diabetic retinopathy which could be investigated [3].

The discussion questions might include the following questions:

• What is the question of the study? What are the main objectives and hypothesis included in the study?
• What is the relevance and rationale of the research question? Mention explicitly why the study was conducted?
• What relevance does the topic of the research has with the field of your practise? If the topic is relevant, how urgent is it in terms of the practise?
• What type of study design or methodological approach was used for the study? Mention the design of the study along with the analysis that has been used for the article.
• What were the results that was obtained from the study? What was found by the investigators from the study?
• What are the strength and weaknesses of the study? Were the results valid that were presented in the article in terms of study design, the method appropriateness, method of data collection, size of the sample , the subject follow up, the influence of the biasness, the analysis method, the discussion and the currentness along with comprehensiveness of the listed references.
• Does the conclusions follow the logical design and the results of the study?
• How does the results obtained from the study can be related to the current practise?
• What influence does the results have on the future practises?

References

[1] Bottoni F, Deiro AP, Giani A, Orini C, Cigada M, Staurenghi G. The natural history of lamellar macular holes: a spectral domain optical coherence tomography study. Graefe's Archive for Clinical and Experimental Ophthalmology. 2013 Feb 1;251(2):467-75.

[2] Ehlers JP. Intraoperative optical coherence tomography: past, present, and future. Eye. 2016 Feb;30(2):193.

[3] Itakura H, Kishi S, Li D, Akiyama H. Observation of posterior precortical vitreous pocket using swept-source optical coherence tomography. Investigative ophthalmology & visual science. 2013 May 1;54(5):3102-7.

[4] Jackson TL, Nicod E, Angelis A, Grimaccia F, Prevost AT, Simpson AR, Kanavos P. Pars plana vitrectomy for vitreomacular traction syndrome: a systematic review and metaanalysis of safety and efficacy. Retina. 2013 Nov 1;33(10):2012-7.

[5] Thapa SS, Thapa R, Paudyal I, Khanal S, Aujla J, Paudyal G, van Rens G. Prevalence and pattern of vitreo-retinal diseases in Nepal: the Bhaktapur glaucoma study. BMC ophthalmology. 2013 Dec;13(1):9.