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Objective: To evaluate the epidemiological correlation between age-related macular degeneration and pseudoexfoliation syndrome in the inhabitants of the island of Crete (Greece). Subjects and Methods: A total of 777 persons (315 men and 462 women, aged 40-99 years), representing a randomized sample (1.43%) of the Cretan population, underwent slitlamp and fundus examinations according to protocol. The results were statistically analyzed. Results: The prevalence of pseudoexfoliation was 16.1% (21.3% in men and 12.6% in women) and that of maculopathy, 7.9% (11.7% in men and 5.2% in women). The conditions were significantly correlated with each other (P = .002). Also, both displayed a significant direct correlation with age and altitude (for pseudoexfoliation, P < .001 and P = .002 for age and altitude, respectively; for age-related macular degeneration, P<.001 for age and for altitude) and an increase in bilateral incidence with progressing age. Conclusions: The observed prevalences of pseudoexfoliation and maculopathy were lower than those reported in the mainland of Greece and other Mediterranean regions. The correlation between age-related macular degeneration and pseudoexfoliation syndrome may be explained by the relationship of each disease with age and altitude. [ABSTRACT FROM AUTHOR]

Purpose: To determine the variability in Scheimpflug image–derived posterior elevation measurements in eyes with keratoconus or corneal collagen crosslinking (CXL). Setting: Eye Institute of Thrace, Alexandroupolis, Greece. Design: Prospective observational study. Methods: Two operators in 2 sessions obtained posterior elevation measurements using the Pentacam Scheimpflug system. Variability in measurements was assessed using Bland-Altman analysis and intraclass correlation coefficients (ICCs). Measurements were associated with a series of Scheimpflug-derived keratoconus indices using the Pearson correlation and multivariate linear-regression analysis. Results: Mean interobserver differences for the central elevation point (e1) and the highest elevation point (HEP) in the keratoconus group were −0.9 μm (95% limits of agreement [LoA], 5.7 to −7.5 μm) and 1.7 μm (95% LoA, 26 to −22.6 μm), respectively. In the CXL group, the mean differences were 0.2 μm (95% LoA, 6.0 to −5.5 μm) and −6.1 μm (95% LoA, 16.8 to −29 μm), respectively. The ICC values in the keratoconus group were satisfactory for most elevation points; the ICC values were unsatisfactory for a series of points in the lower corneal hemisphere. The ICC values for points in both hemispheres were unsatisfactory in the CXL group; HEP had adequate reproducibility. The e1 and HEP parameters correlated significantly with most Scheimpflug-derived indices (P<.05) in the keratoconus group but not in the CXL group. Regression analysis indicated that the central keratoconus index was the primary determinant of the variability in keratoconus eyes. Conclusions: Scheimpflug-derived posterior elevation measurements had acceptable reproducibility in keratoconus eyes and post-CXL eyes. Less consistent measurements were obtained in the lower hemisphere. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

Purpose: To assess the beliefs and preferences of 6th year Greek medical students, regarding medical profession and the specialty selection process, in the years of financial crisis., Setting: Democritus University of Thrace, Medical School, Alexandroupolis, Greece., Material and Methods: A custom questionnaire based on former similar studies was developed and administered to senior medical students. Further to demographics, the questionnaire gathered information on perceptions and trends regarding medical profession, the specialty and residency selection processes. Total question scores were summed for comparisons among questions. Mean scores and standard deviations were calculated for comparisons between student groups., Results: 111 students responded successfully to the instrument. "Helping patients" and the "scientific basis of medicine" were the fundamental reasons for choosing the medical profession. Compared to women, male students placed greater importance on the "financial allowances" (men: 3.73±1.03, women: 3.05±1.30, p=0.01). Regarding the selection criteria for a certain specialty, "challenging specialty" and "bedside specialty", were the main influence factors. Men more strongly preferred a specialty that could "financially support their desired lifestyle" (men: 3.93±0.88, women: 3.41±1.30, p=0.02). Concerning selection criteria of a residency program, students chose a "well structured" program at a "recognized hospital/department". Regarding the country of preference for their residency, 86% planned to continue abroad, primarily in Germany and the United Kingdom., Conclusion: Greek medical students perceive the medical profession and the specialty process in a similar way like their colleagues form Western countries. However, the vast majority identify that migration to another country is the most promising alternative choice for their medical career., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To evaluate the psychometric properties of the Greek National Eye Institute Refractive Error Quality of Life Questionnaire (NEI-RQL-42)., Methods: We developed the Greek version of the instrument using forward and backward translation. To examine reliability, Cronbach alpha for each subscale was used as an index of internal consistency. Test-retest reliability was evaluated with intraclass correlation coefficients (ICC). Regarding construct validity, both convergent and discriminant validities were calculated by means of multi-trait analysis. Furthermore, the instrument was evaluated by Rasch analysis, as well., Results: Three patient groups were studied (emmetropes (n = 20), myopes (n = 41), and hyperopes (n = 18)). Emmetropes scored significantly better in the majority of subscales, while myopes scored better than hyperopes in clarity of vision (p = 0.012), near vision (p<0.001), and satisfaction with correction (p = 0.001). Cronbach alpha ranged from 0.490 (glare) to 0.948 (expectations), with most subscales having high internal consistency. The ICCs ranged from 0.76 to 0.93 for all subscales. All items passed the convergent and discriminant validity tests. Strong correlations were detected between uncorrected visual acuity and near vision, expectations, activity limitations, dependence on correction, worry, and suboptimal correction subscales. Rasch analysis revealed potential weaknesses of the instrument that are associated with the assumptions of the model itself. Specifically, 3 items and 17.5% of the participants fell outside the tolerance box. Moreover, principal component analysis indicated average unidimensionality for the instrument., Conclusions: Traditional validation methods indicate that the Greek NEI-RQL-42 scale has adequate psychometric properties for comparative studies in local populations. Rasch analysis indicates significant misfits to the model that should be taken into consideration and evaluated in future studies. These misfits might reflect inherent weaknesses of the original NEI-RQL-42 and not of its adaptation to Greek norms.

Purpose: To develop a reliable and practical questionnaire for glaucoma awareness and evaluate the impact of potential determinants., Methods: Patients with primary open-angle, pigmentary, and exfoliation glaucoma, as well as healthy controls, were recruited. The instrument included questions about demographic characteristics, as well as 8 questions assessing the participant's familiarity with glaucoma. Rasch analysis was used for the validation of the questionnaire. The effect of demographics as potential determinants of awareness was examined with a multivariate logistic regression analysis. Bonferroni-corrected statistical significance was tested with the Mann-Whitney U test or one-way analysis of variance. Association between demographics and questionnaire scores was examined with Spearman correlation., Results: As indicated by power analysis, responses from 175 patients (mean age 65.5 years) and 314 controls (mean age 43.3 years) were analyzed. Rasch analysis indicated no multidimensionality and good item-person targeting. Mean ± SD awareness scores for the glaucoma and control groups were 4.43 ± 2.10 and 4.20 ± 2.11, respectively (p=0.207). Sex and residence were not predictors of disease awareness, whereas educational level was only a determinant in the control group (p<0.001). Income was a predictor only for patients (r=0.357, p<0.001), whereas family history was predictive for both groups (p<0.001). Logistic regression analysis revealed that only family history was associated with increased awareness (Chi(2)=4.61, p=0.03, odds ratio 1.98)., Conclusions: This study introduces a practical and valid instrument for the assessment of glaucoma awareness.

Purpose: The aim of the study was to assess the vision-specific quality-of-life (VS-QoL) of Greek glaucoma patients, and the impact of potential influencing factors., Methods: This was a 2-center, cross-sectional study. One hundred twenty-one patients were recruited from the outpatient glaucoma service and 100 successfully responded to the self-administered, Greek version of the National Eye Institute Visual Function Questionnaire 25. The results were quantified in terms of scores (0-100) and correlations with possible modifiers were investigated. The effects of sex, income, education, and comorbidities on VS-QoL scores were examined by analysis of variance., Results: Our sample consisted of 49 men and 51 women with a mean age of 64.1 years, ranging from 18 to 89 years. The QoL score (mean+/-SD) was 81.7+/-14.7, the mean general health subscale score was 57.3+/-21.0 and the mean general vision subscale score was 72.7+/-16.3. Men generally presented higher VS-QoL scores (P=0.042). Age had a negative impact on the "General health" (rho=-0.325, P=0.001) and "General vision" (rho=-0.265, P=0.008) subscales. Higher educational background contributed to higher scores in General health, "General vision," and "Central vision" while urban residence correlated with "Distant activities" and "Social functioning". Cup-to-disc ratio, visual acuity and visual field indices like the Advanced Glaucoma Intervention Study, the Hodapp-Anderson-Parrish, and the Collaborative Initial Glaucoma Treatment Study scores, and pattern standard deviation and mean deviation all correlated with National Eye Institute Visual Function Questionnaire scores (r values ranging from -0.240 to 0.757)., Conclusions: In this first study in a Greek native population, both the structural measure of cup-to-disc ratio and a multitude of functional scores correlated with VS-QoL scores in glaucoma patients.