Comparing paediatric optometric vision care in Canada over a 14-year period

PURPOSE

In Canada, teaching in paediatric eye care has increased in the past decade both within the optometry curriculum and as continuing education to optometrists. Paediatric vision care guidelines have also been established by North American optometric associations. This study examined whether this exposure was associated with changes in paediatric eye care in Canada over a 14-year period.

METHODS

Canadian optometrists were invited to participate in an anonymous 35-item survey in 2007 and 2021. The surveys sought to investigate optometrist's recommendations for first eye examinations, the number of paediatric patients seen in a typical week and preparedness to provide eye examinations to children. Response frequencies were determined for each survey item.

RESULTS

Across Canada, 133/1000 (13.3%) and 261/~6419 (~4.1%) optometrists responded to the survey in 2007 and 2021, respectively. No significant difference was found in the number of years practicing, days per week in practice and total number of patients seen per week. The modal age optometrists recommended children be seen for their first eye examination changed from 3-4 years in 2007 (53%) to 6-12 months in 2021 (61%). In 2007, 87% of respondents provided eye examinations to children <2 years, increasing to 94% in 2021 (p = 0.02). Despite a reduction in the recommended age between the two survey years, the most frequent age children were seen for their first eye examination was 3-4 years (30% in both surveys) and the most common age seen in a typical week remained unchanged (4-6 years-56% 2007; 66% 2021).

CONCLUSION

Although optometrists' willingness to provide paediatric eye care increased over the past 14 years, the number of children seen in a typical week did not change. Barriers to determine why more children are not being seen at an earlier age need to be investigated.

Eye Care Service Use and Associated Health-Seeking Behaviors Among Malawian Adults: Secondary Analysis of the Malawi Fifth Integrated Household Survey 2019-2020

Background

The use of eye care services varies among different population groups.

Objective

This study aimed to assess self-reported eye care use (ECU) and associated demographic factors among Malawian adults.

Methods

This study used secondary data from the Malawi Fifth Integrated Household Survey 2019-2020, a nationally representative survey. The study included 12,288 households and 27,336 individuals 15 years and older. We entered age, sex, level of education, residency (urban/rural), and chronic disease into a logistic regression model, and used a confusion matrix to predict the model's accuracy. A P value <.05 was considered statistically significant.

Results

About 60.6% (95% CI 60.0%-61.2%) of those with eye problems accessed formal care 2 weeks before the survey date. A logistic regression model showed that ECU was positively associated with education compared to none (odds ratio [OR] 6.6, 95% CI 5.927-7.366; P<.001), males compared to females (OR 1.2, 95% CI 1.104-1.290; P<.001), and urban residence compared to rural (OR 1.2, 95% CI 1.118-1.375; P<.001). ECU was negatively associated with age (OR 7, 95% CI 6.782-8.476; P<.001) and having chronic diseases (OR 0.6, 95% CI 0.547-0.708; P<.001).

Conclusions

Social support, women empowerment, education, and mobile clinics are key strategic areas that would increase access to eye care in Malawi. Further studies can investigate ECU among the pediatric population.

Disparities in Eye Care Utilization Among Refugee and Migrant Populations

Purpose

In this cross-sectional study, we examined refugee/migrant participants' health and eye care utilization compared to controls in San Diego County.

Methods

Data were collected from electronic health records (EHRs) at UCSD Health-affiliated medical centers. Through a manual review of EHRs, eligibility criteria to identify a cohort were developed. A total of 64 refugee/migrant participants and 95 control participants matched based on country of origin, age, and sex were included in the analysis. Demographic characteristics, insurance type, and vision/eye care utilization were compared between the two groups.

Results

A greater proportion of refugee/migrant participants were more likely to be enrolled in government-sponsored insurance programs, predominantly Medicaid when compared to controls (55% vs. 24%, P = < 0.01). When adjusting for age, history of ophthalmic procedure, and surgery, refugee status was associated with fewer encounters with ophthalmologists in a multivariable linear regression model (coefficient = -1.66 [95% confidence interval [CI] = -2.89 to -0.44], P = 0.009).

Conclusions

This study highlights disparities in eye care utilization for refugee/migrant populations. When compared to controls, a larger proportion of refugees/migrants had government-funded insurance, and refugee status was associated with fewer encounters with ophthalmologists. These findings underscore the need for further research on this population to better understand potential healthcare barriers these individuals may encounter.

Translational Relevance

This analysis of EHR data illustrates disparities in eye care experienced by refugees/migrants, highlighting potential gaps in care in a vulnerable population.

Bloodborne viral infections: Seroprevalence and relevance of preoperative screening in Indian eye care system - A retrospective study

PURPOSE

To report the seroprevalence of bloodborne viral infection (BBVI) in patients undergoing ophthalmic surgeries and assess the utility and feasibility of preoperative screening for BBVI in India's current eye care system.

METHODS

This retrospective, hospital-based, descriptive study included data from patients undergoing preoperative screening for Hepatitis B virus (HBV), Hepatitis C virus (HCV), and human immunodeficiency virus (HIV) at a tertiary eye care institute from 2018 to 2022. Rapid diagnostic tests (RDTs) were performed on the blood samples after obtaining informed consent from the patients. Seroreactive patients underwent surgery with additional safety precautions. The demographic data and surgical details of these patients were collected and analyzed. ANOVA was used to carry out statistical analysis between groups. During the study period, the number of healthcare workers (HCWs) sustaining needle stick injury (NSI) and accidental sharp injury (ASI) in the operating theater (OT) and details of these injuries were recorded.

RESULTS

Samples from 28,563 patients were included. The seroprevalence of BBVI was 1.87% (536/28563). Hepatitis B virus (322, 60.1%) was the most commonly detected infection, and HIV (59, 11%) was the least detected infection. The mean age of the seroreactive patients was 60.3 ± 30.8 years. The incidence of NSI was 0.49/1000 surgeries. Nurses (11) and technicians (4) in the OT sustained maximum NSI. None of the HCWs had seroconversion after NSI.

CONCLUSION

The overall seroprevalence of BBVI in the current study is lower than that reported in previously published studies from eye care organizations. Currently, mandatory preoperative screening for BBVI to prevent transmission of these infections to HCWs working in the eye care sector in India appears to be less cost-effective.

Status of Vision and Eye Care Among Patients in Rehabilitation Hospital Units: A Cross-Sectional Study

OBJECTIVES

The prevalence of vision disorders is high among geriatric and hospital inpatient populations, yet they often go undetected, resulting in consequences such as falls or prolonged recovery time. A needs assessment study was conducted to investigate levels of vision and the potential prevalence of unmanaged/undiagnosed ocular disorders among adult inpatients in a hospital-based rehabilitation unit.

DESIGN

Cross-sectional study.

SETTING & PARTICIPANTS

Inpatient rehabilitation units of an acute care hospital system in Ontario, Canada. Adults (n = 112) in a hospital inpatient rehabilitation unit participated from October 2018 to February 2019.

METHODS

Participants were surveyed regarding their demographic, ocular, and medical data and spectacle wear. Visual acuity, contrast sensitivity, visual fields, and stereoacuity plus the spectacle condition were directly assessed.

RESULTS

The majority (75%) were found to have reduced habitual vision while in hospital. Nearly 60% of participants reported at least some difficulty reading a newspaper or distinguishing a face or were "not happy with their vision." This was despite 80% of participants reporting that they had an eye care practitioner and 70% that they had an eye examination within the last 2 years. More than half (51.8%) of the participants received the recommendation to follow up with their eye care practitioner on discharge from the hospital.

CONCLUSIONS AND IMPLICATIONS

Reduced vision and vision disorders has a high prevalence among hospital patients in rehabilitation units and should be evaluated at or soon after hospital intake. By incorporating vision screening tools, necessary precautions may be taken to avoid possible falls and promote recovery.

Trends in the Ophthalmic Workforce and Eye Care Infrastructure in South India: Cross-Sectional Questionnaire Study

BACKGROUND

This study is part of broad-based research to determine the impact of blindness control activities in general and with special reference to the Andhra Pradesh Right to Sight Society (APRTSS) activities in the southern Indian states of Andhra Pradesh and Telangana. As part of the global "VISION 2020: The Right to Sight" initiative, the APRTSS was established in the undivided state of Andhra Pradesh in 2002. Since then, the APRTSS has been actively implementing the strategies of VISION 2020 to reduce visual impairment and blindness in the state.

OBJECTIVE

The availability and distribution of the eye care workforce are essential to reach the goals of VISION 2020: The Right to Sight, the global initiative to eliminate avoidable blindness. This study assessed the trends in the availability and distribution of eye health professionals and eye care infrastructure in 2 southern Indian states: Andhra Pradesh and Telangana.

METHODS

This cross-sectional study used a pretested questionnaire to gather data for the year from 2012 to 2013. Data for 2002 to 2003 were collected from available historical records. The questionnaires were pretested in a pilot study conducted before the main survey. Pretested questionnaires were administered to all eye care professionals-ophthalmologists (n=1712) and midlevel ophthalmic personnel (MLOP; n=1250)-eye care facilities with ≥10 inpatient beds or performing ≥100 cataract surgeries per annum (n=640), local nongovernmental eye care organizations (n=182), and international eye care organizations (n=10). Data were collected for 2 different time periods: the baseline year of 2002 to 2003 and the target year of 2012 to 2013. Data analysis was conducted using SPSS version 19.0.

RESULTS

The response rates were 81.1% (519/640) for eye care facilities, 96.1% (1645/1712) for ophthalmologists, and 67.6% (845/1250) for MLOP. From 2002-2003 to 2012-2013, there has been an increase in eye care facilities, from 234 to 519 (121.8%); ophthalmologists, from 935 to 1712 (83.1%); and MLOP, from 767 to 1250 (63%). The ophthalmologist:population ratio improved from 1:88,260 in 2002-2003 to 1:51,468 in 2012-2013. The MLOP:population ratio improved from 1:168,283 in 2002-2003 to 1:138,117 in 2012-2013 but still falls short of the ideal number.

CONCLUSIONS

Both southern Indian states are able to meet the requirements for ophthalmologists and eyecare infrastructure as per the goals of VISION 2020. However, the number of MLOP falls short of the ideal ratio for the population. This study has some limitations. For example, most of the data collected through questionnaires were based on self-report, which might introduce bias due to memory recall or over or under-reporting of certain information. However, this was addressed by cross-checking the collected data with information from supplementary sources.

Genetic testing and gene therapy in retinal diseases: Knowledge and perceptions of optometrists in Australia and New Zealand

With advances in gene-based therapies for heritable retinal diseases, primary eye care clinicians should be informed on ocular genetics topics. This cross-sectional survey evaluated knowledge, attitudes, and concerns regarding genetic testing and gene therapy for retinal diseases among optometrists in Australia and New Zealand. Survey data included practitioner background, attitudes and practices towards genetic testing for monogenic inherited retinal disease (IRDs) and age-related macular degeneration, and knowledge of ocular genetics and gene therapy. Responses were received from 516 optometrists between 1 April and 31 December 2022. Key perceived barriers to accessing genetic testing were lack of clarity on referral pathways (81%), cost (65%), and lack of treatment options if a genetic cause is identified (50%). Almost all respondents (98%) believed that ophthalmologists should initiate genetic testing for IRDs and fewer understood the role of genetic counsellors and clinical geneticists. This study found that optometrists in Australia and New Zealand have a high level of interest in ocular genetics topics. However, knowledge gaps include referral pathways and awareness of genetic testing and gene therapy outcomes. Addressing perceived barriers to access and promoting sharing of knowledge between interdisciplinary networks can set the foundation for genetic education agendas in primary eye care.

The impact of having a free community eye clinic located inside a homeless shelter: a retrospective analysis of patient demographics

Worsening vision is a life-altering process that affects individuals in many aspects of daily life. While worsening vision can be caused by normal physiological processes that occur with age, there can be underlying systemic or ocular diseases that may be the root cause. Routine eye exams can screen for disease as well determine the degree of vision correction required to attain acceptable vision. Access to an eye exam ordinarily requires vision insurance and one must consider the added expense of glasses if they are recommended. While this can be a life-improving visit for many, there are several socioeconomic barriers that discourage homeless and low-income individuals from being able to access this service. The lack of resources to access regular eye exams and the resulting inadequate eye care may lead to underdiagnosis of serious ocular pathology. The Kansas City Free Eye Clinic is located inside a homeless shelter and, therefore, provides a convenient location for homeless and low-income individuals to receive comprehensive eye exams as well as prescription glasses at no cost. In this paper, we discuss the unique setup and demographics of this student-run eye clinic and the ways in which it has served the Kansas City population and how its integration into a homeless shelter could serve as a role model for free community eye clinics.

Nationwide and regional trends in distance and near visual acuities during 2000-2017 in Finland

PURPOSE

To evaluate time trends in distance and near vision at the national and regional levels during 2000-2017 in Finland.

METHODS

We used three cross-sectional, nationwide health examination surveys representing the Finnish adult population aged 30 years or older in 2000, 2011 and 2017. Bilateral, habitual distance and near visual acuity (VA) were measured in all three surveys.

RESULTS

The prevalence of good distance vision (VA ≥ 1.0) increased from 76.7% to 81.3% during 2000-2017 while the prevalence of weak or worse distance vision (VA ≤ 0.5) decreased from 7.6% to 3.7%. The improvements were largest among those aged 85 years and older: the prevalence of distance VA ≤ 0.5 decreased from 71.8% to 28.3%. Near vision showed improvement to a lesser extent in the total population; nevertheless, among those aged 85 years and older the prevalence of weak or worse near vision (VA ≤ 0.5) decreased from 62.3% to 27.1%. A similar positive time trend was observed in all main regions of Finland, and differences between urban and rural regions were small.

CONCLUSION

During the past two decades, the overall vision level has improved among the adult population. This is explained mostly by a positive shift from lower to higher vision levels among older age groups, indicating that people live longer with good or adequate vision. This positive trend showed remarkable similarity throughout different regions in Finland, highlighting the importance of equal and accessible eye care throughout the country.

A community-based cross-sectional study of eye care service utilization among the adult population in southern Ethiopia

Background

Visual impairment, which is related to many eye diseases, is a major public health problem. If detected and treated early, it can be prevented; therefore, regular use of vision services is very important.

Objective

This study aimed to assess the proportion of utilization of eye care services and associated factors among the rural community population in southern Ethiopia.

Methods

A community-based cross-sectional study design with a two-stage cluster random sampling technique was conducted to collect data from adults aged 40 years and above using interviewer-administered questionnaires. Kebeles were randomly selected by the lottery method, and systematic random sampling with proportional distribution was used to select the households. An adult individual was randomly selected from a household when there was more than one adult available. A binary logistic regression model was used to establish the association between eye care service utilization and the variables that might affect it.

Results

Of the 551 study population, 510 responded to this study, and the response rate was 92.6%. The mean age of the respondents was 52.2 years. The rate of eye care service utilization was 29% (95% confidence interval (0.25, 0.33)). The study shows that older participants, aged 65 and above (adjusted odds ratio: 4.04; 95% confidence interval (2.20, 7.43)), having previous eye problems (adjusted odds ratio: 10.04; 95% confidence interval (5.81, 17.33)), the presence of systemic illness (adjusted odds ratio: 2.52; 95% confidence interval (1.21, 5.21)), and having awareness about regular checkups (adjusted odds ratio: 11.75; 95% confidence interval (6.62, 20.84)) were found to be the predictors of eye care service utilization.

Conclusion

In this study, utilization of eye care services was low. Older age, previous eye problems, systemic illness, and awareness about checkups were found to be predictors of eye care service utilization. Hence, there is a need to increase the absorption of existing ophthalmic services and create awareness of the use of ophthalmology services to reduce preventive blindness.

Recruiting Populations at Higher Risk for Glaucoma and Other Eye Diseases Experiencing Eye Health Disparities

PURPOSE

We compared recruitment of participants at high risk for glaucoma and other eye diseases in three community-based studies designed to improve access to eye care in underserved populations in New York City, Alabama, and Michigan.

METHODS

We used (1) participant data collected at enrollment (e.g. demographic, medical conditions, healthcare access, and method of hearing about study) and (2) interviews with study staff to assess effective recruitment strategies in enrolling people at high risk for eye disease. We analyzed participant data using descriptive statistics and interview data using content analysis to categorize responses to questions.

RESULTS

In these community-based studies, all sites recruited greater proportions of populations with increased risk of eye disease compared to their estimates in the US population. High-risk characteristics varied based on the setting (i.e. Federally Qualified Health Centers or affordable housing buildings). Older adults represented 35% to 57%; 43% to 56% identified as Black; 1% to 40% as Hispanic/Latino; 20% to 42% reported a family history of glaucoma; 32% to 61% reported diabetes; and 50% to 67% reported high blood pressure. Social risk factors for under-utilization of eye care due to poverty included that 43% to 70% of participants had high school or lower education; 16% to 40% were employed; and 7% and 31% had no health insurance. From a qualitative perspective, active, personalized, culturally sensitive methods were most effective in recruiting participants.

CONCLUSION

Implementing eye disease detection interventions in community-based settings facilitated recruiting individuals at high risk for glaucoma and other eye diseases.

Ocular toxicities associated with antibody drug conjugates and immunotherapy in oncology: clinical presentation, pathogenesis, and management strategies

INTRODUCTION

The development of molecularly targeted anticancer therapies and immunotherapy continues to revolutionize the treatment of cancer. FDA accelerated approvals of novel targeted therapies allowed for introduction of these agents into the clinic at a rapid rate. On-and off-target ocular toxicities are prevalent treatment-related adverse events of newer therapies including antibody drug conjugates (ADCs) and immunotherapy. Ocular toxicities associated with ADCs and immunotherapy have heterogeneous presentations and pathogenesis requiring unique and often complex monitoring, and management.

AREAS COVERED

In this article, we provide an updated review of treatment-emergent ocular toxicity associated with new and novel oncologic therapies and summarize guidelines and best practice strategies for prevention, monitoring and management. A literature search was performed through PubMed, ClinicalTrials.gov, and FDA website (1 January 2017 to 10 May 2023) to identify relevant information.

EXPERT OPINION

The implementation of a strategy for monitoring, prevention, and management of treatment-related ocular toxicities involves a multi-disciplinary, often cross-center approach. Communication with infusion nursing leadership, clinic staff, and eye care providers is crucial to the successful implementation of eye care plans to prevent and manage ocular toxicity.

The paediatric optometry alignment program - a model of interprofessional collaborative eyecare

CLINICAL RELEVANCE

Collaboration  between hospital-based ophthalmology and community-based optometry could pave the way to improve access to paediatric eyecare services.

BACKGROUND

The Paediatric Optometry Alignment Program (POAP) began in 2016 as a proof-of-concept pilot project that aimed to improve access to specialist paediatric ophthalmology services. If found to be effective at improving patient access, and the quality of care acceptable to patients and professionals then the strategic intent was to upscale the programme to  serve as a model for paediatric eye care in the community.

METHODS

Temporal observational trend analysis was used to review ophthalmology clinic appointment waitlists prior and post POAP pilot project commencement. Family satisfaction with post-discharge care was surveyed in a purposive sample of 30 patients.  Aligned optometrists in the program pilot (n = 97) were invited to complete an online survey (response rate 46%; n = 45).

RESULTS

The percentage of children waiting longer than clinically recommended fell from 72% to 36%. Sixty-seven percent  of surveyed families had attended a community optometrist as recommended, and all rated the optometry experience from good to excellent.  Participating optometrists reported high levels of satisfaction with involvement in the program, and increased confidence and involvement in paediatric eye care delivery. The need to improve formal transfer  of clinical information was identified.

CONCLUSION

Facilitated integrated care between community-based optometrists and a hospital-based ophthalmology department can improve access for tertiary care services, with high satisfaction for families and participating community-based optometrists.

Predictors of Nurses' Practice of Eye Care for Patients in Intensive Care Units

Introduction

Taking care of patients' eyes is an important nursing skill. Nurses must be capable of providing a standard assessment of the eye and vision as well as necessary care such as eye cleaning. Intensive care unit (ICU) nurses typically focus on life-threatening issues while giving little attention to other serious issues. The purpose of this study was to assess predictors of nurses' practice of eye care for patients in ICUs in the West Bank.

Method

A cross-sectional study was conducted with all ICU nurses from West Bank hospitals. The researchers developed a self-administered questionnaire to collect data.

Results

One hundred and fifty-two nurses participated in this study. The findings revealed that the mean age of nurses was 31.2 (SD  =  7.5) years. The analysis revealed that only 0.7% had a good knowledge level, 7.2% had a fair knowledge level, and 25.7% had a good practice level of eye care for patients in an ICU. Knowledge of patients' eye care in the ICU, as well as an eye care protocol or policy for unconscious patients, was found to be significant predictors of practice (p < .001).

Conclusion

The study confirmed that the nurses had poor knowledge and inadequate practice of eye care for patients in the ICU. Also, the study confirmed that a nurse's knowledge of patients' eye care in the ICU and an eye care protocol or policy for unconscious patients were significant predictors of practice.

A Scoping Review on Determining Australian Nurse Engagement in Eye Care Settings

Purpose

As the Australian population grows and ages, the demand for eye care services, and nurses to provide the services, is expected to increase. This will impact nurses, who are Australia's largest health-care provider group. Understanding and mapping the current role and use of nurses in eye care is an essential first step for future health workforce planning and development. To map their engagement, we undertook a scoping review to gain an understanding of the current Australian nurse eye care workforce landscape, to help guide and support future workforce development activities. Secondly, we evaluated if publications in this field incorporated or mentioned the Australian Ophthalmic Nursing Association's National Standards (Practice standards) in their publication. This review also offers other nations and eye care providers the opportunity to evaluate their own health workforce plan and nurse utility.

Study Design and Methods

We conducted a review of academic and grey literature, via various search engines, and an inclusion and exclusion criteria.

Results

We uncovered 11 publications. Of those, five were academic papers examining extended and advanced nursing practice, one was a letter to the editor, two were industry feature reviews, two were industry reports and the final was the Practice Standards. Key themes throughout indicated the benefit of nurse training and nurse involvement in eye care. Overall, there was insufficient information or data to describe nurse deployment, practice and utility. Finally, the Practice Standards were not referenced in any publication.

Conclusion

There is insufficient published information to calculate the level and involvement of nurses, or describe their existing role, advancement or future deployment in eye care in Australia. Without clear information, Australia is unable to develop effective health workforce strategies to attract, train, retain, and appropriately deploy nurses to meet future eye care needs.

The Accuracy of a Web-Based Visual Acuity Self-assessment Tool Performed Independently by Eye Care Patients at Home: Method Comparison Study

BACKGROUND

 Telehealth solutions can play an important role in increasing access to eye care. Web-based eye tests can enable individuals to self-assess their visual function remotely without the assistance of an eye care professional. A web-based tool for self-assessing visual acuity (VA) has previously been studied in controlled, supervised conditions. The accuracy of this tool when performed independently by patients in their home environment, using their own devices, has not yet been examined.

OBJECTIVE

 The objective of this paper was to examine the accuracy of a web-based tool with respect to measuring VA in ophthalmic patients in their home environment, compared with a conventional in-hospital assessment using a Snellen chart (the gold standard).

METHODS

 From April through September 2020, consecutive adult patients with uveitis at the University Medical Center Utrecht, the Netherlands, performed the web-based VA test at home (the index test) before their upcoming conventional VA assessment at the hospital (the reference test). The agreement between the 2 tests was assessed by the Bland-Altman analysis. Additional analyses were performed to investigate associations between clinical characteristics and the accuracy of the web-based test.

RESULTS

 A total of 98 eyes in 59 patients were included in the study. The difference in VA between the index and reference tests was not significant, with a mean difference of 0.02 (SD 0.12) logMAR (P=.09) and 95% limits of agreement of -0.21 to 0.26 logMAR. The majority of the differences (77%) fell within the predetermined acceptable deviation limit of 0.15 logMAR. In addition, no patient characteristics or clinical parameters were found to significantly affect the accuracy of the web-based test.

CONCLUSIONS

 This web-based test for measuring VA is a valid tool for remotely assessing VA, also when performed independently by patients at home. Implementation of validated web-based tools like this in the health care system may represent a valuable step forward in revolutionizing teleconsultations and can provide individual patients with the opportunity to self-monitor changes in VA. This is particularly relevant when the patient's access to ophthalmic care is limited. Future developments should focus on optimizing the testing conditions at home to reduce outliers.

What the Canadian public (mis)understands about eyes and eye care

CLINICAL RELEVANCE

Inadequate public knowledge about eyes and eye care poses avoidable risks to vision-related quality of life.

BACKGROUND

This study of eye care knowledge among Canadians extends earlier findings from focus groups.

METHODS

Perceptions about eyes and eye care were sought using a 21-item online survey and snowball sampling. Inclusion criteria were living in Canada and being at least 18-years old; eye care professionals and staff were excluded. Response frequencies were converted to percentages, with eye condition items analysed according to 'expected' or 'unexpected' eye impacts. Proportions selecting these impacts or 'unsure' were determined.

RESULTS

There were 424 respondents: 83.0% aged 20-65 years and 69.6% female. Mismatches existed between perceived recommendations and behaviours for booking eye exams: within two years (86.7% vs. 68.4%) and symptom-driven (3.3% vs. 13.0%). First eye exams after age one year were deemed appropriate by 43.6%. Few respondents associated glaucoma with no symptoms (6.0%) or amblyopia with blurred vision (13.5%). A notable proportion incorrectly related tunnel vision with age-related macular degeneration (AMD, 36.8%) and cataract (21.9%). Identifying all 'expected' responses was unlikely for glaucoma (1.9%), amblyopia (6.7%), and cataract (12.0%). Most respondents identified no 'expected' effects for glaucoma (63.8%) and AMD (46.2%) and some 'expected' effects for cataract (59.5%) and amblyopia (72.6%). Selecting 'unsure' was 9-10 times more common among respondents choosing no 'expected' impacts than those choosing some. Awareness of thyroid-associated eye disease was lowest (32.4%) of seven conditions. Respondents were most likely to consult optometrists for routine eye exams, eye disease, diabetes eye checks and blurred vision but family physicians for red eyes and sore eyes. Respondents typically paid for their eye exams and eyewear but wanted government to pay.

CONCLUSION

Vision-threatening knowledge gaps and misinformation about eyes and eye care among Canadian respondents highlight the need for accessible, targeted public education.

The Role of Optometry in the Delivery of Eye Care via Telehealth: A Systematic Literature Review

Objective: Optometrists are increasingly adopting teleoptometry as an approach to delivering eye care. The coronavirus disease 2019 (COVID-19) pandemic has created further opportunities for optometrists to utilize innovation in telehealth to deliver eye care to individuals who experience access barriers. A systematic literature review is presented detailing the evidence to support the use of teleoptometry. Methods: Databases of MEDLINE, Global Health, and Web of Science were searched, and articles were included if they reported any involvement of optometrists in the delivery of telehealth. Findings were reported according to the mode of telehealth used to deliver eye care, telehealth collaboration type, and the format and geographical areas where eye care via telehealth is being delivered. Results: Twenty-seven relevant studies were identified. Only 11 studies included the role of optometrists as a member of the telehealth team where the scope of practice extended beyond creating and receiving referrals, collecting clinical data at in-person services, and continuing in-person care following consultation with an ophthalmologist. Both synchronous and asynchronous telehealth services were commonly utilized. Optometrists were most commonly involved in ophthalmology-led telehealth collaborations (n = 19). Eight studies reported optometrists independently delivering primary eye care via telehealth, and commonly included videoconferencing. Conclusion: The application of teleoptometry to deliver eye care is rapidly emerging, and appears to be a viable adjunct to the delivery of in-person optometry services. The review highlighted the scarcity of evidence surrounding the clinical benefits, safety, and outcomes of teleoptometry. Further research is required in this area.

Adherence to Urgent Eye Visits during the COVID-19 Pandemic: A Population Characteristics Study

PURPOSE

To explore individual and community factors associated with adherence to physician recommended urgent eye visits via a tele-triage system during the COVID-19 pandemic.

METHOD

We retrospectively reviewed acute visit requests and medical exam data between April 6, 2020 and June 6, 2020. Patient demographics and adherence to visit were examined. Census tract level community characteristics from the U.S. Census Bureau and zip code level COVID-19 related death data from the Cook County Medical Examiner's Office were appended to each geocoded patient address. Descriptive statistics, t-tests, and logistic regression analyses were performed to explore the effects of individual and community variables on adherence to visit.

RESULTS

Of 229 patients recommended an urgent visit, 216 had matching criteria on chart review, and 192 (88.9%) adhered to their visit. No difference in adherence was found based on individual characteristics including: age (p = .24), gender (p = .94), race (p = .56), insurance (p = .28), nor new versus established patient status (p = .20). However, individuals who did not adhere were more likely to reside in neighborhoods with a greater proportion of Blacks (59.4% vs. 33.4%; p = .03), greater unemployment rates (17.5% vs. 10.7%; p < .01), and greater cumulative deaths from COVID-19 (56 vs. 31; p = .01). Unemployment rate continued to be statistically significant after controlling for race and cumulative deaths from COVID-19 (p = .04).

CONCLUSION

We found that as community unemployment rate increases, adherence to urgent eye visits decreases, after controlling for relevant neighborhood characteristics. Unemployment rates were highest in predominantly Black neighborhoods early in the pandemic, which may have contributed to existing racial disparities in eye care.

The Comparison of Intraocular Pressure Measured by Transpalpebral Method Using Diaton and Rebound Tonometry by iCare in the Eyes Before and After Transepithelial Photorefractive Keratectomy (TPRK) in Saudi Arabia

INTRODUCTION

Intraocular pressure (IOP) measurement is vital to select and monitor a patient undergoing ocular surgery. The validity of tonometry by independent researchers is useful. In this paper, we compare intraocular pressure (IOP) by rebound tonometry using iCare (Tiolat Oy, Helsinki, Finland) with transpalpebral IOP (tpIOP) method by using Diaton (Bicom Inc., NY, USA) before and after transepithelial photorefractive keratectomy (TPRK) in Saudi Arabia.

METHODS

This cross-sectional validity study was held at a private ophthalmology hospital in central Saudi Arabia from January 2021 to February 2022. The tonometry was performed before, at week 1 (W1), and month 1 (M1) after TPRK. The tpIOP and IOP by iCare were compared using matched-pair analysis. The agreement in IOP by two methods was reviewed using the Bland-Altman plot. Central corneal thickness (CCT), spherical equivalent (SE) before surgery, and gender were correlated to the difference in IOP by two tonometers. The main outcome was the difference in IOP measured by Diaton and iCare.

RESULTS

We studied 202 eyes of 101 patients. The median difference in IOP by Diaton and iCare was -1.0 mmHg before, at W1, and M1 follow-ups. Before surgery, tpIOP by Diaton was 15.0±2.8 mmHg and by iCare was 16.0±3.7 mmHg (P<0.001). At W1, tpIOP was 15.9±2.5 mmHg and 16.9±3.4 mmHg by iCare (P<0.001). At M1, tpIOP was 15.7±4.1 mmHg and 16.5±5.4 mmHg by iCare (P<0.001). IOP by two methods was within ±2 mmHg in 73.3%, 69.8%, and 75.2% of the eyes before, at W1, and M1 of TPRK. Pre-CCT (P<0.001) was the significant predictor of the difference in IOP by two methods at W1 and M1 (P=0.001). iCare gave the overestimation of IOP compared to Diaton in 18.3%, 22.8%, and 17.8% of the eyes before, W1, and M1 follow-ups.

CONCLUSIONS

IOP by iCare and Diaton was similar. Central corneal thickness was the predictor of IOP differences by tonometers.

Knowledge and Practices of Child Eye Healthcare Among Parents in Aseer Region, Saudi Arabia

BACKGROUND

The majority of causes of childhood blindness are preventable and treatable. There are an estimated 1.4 million blind children worldwide, with roughly three-quarters of them living in developing countries. In most low-income countries, school-age children account for 20%-30% of the total population.

AIM

To evaluate parents' knowledge, attitudes, and practices related to pediatric eye medical services in Saudi Arabia's Aseer region.

METHODOLOGY

A descriptive cross-sectional approach was used targeting all parents in the Aseer region. Data were collected using a structured questionnaire developed by the study investigators. The questionnaire included parents' sociodemographic data and a family history of blindness or visual disability. Parents' awareness regarding pediatric eye care was assessed using relevant items. The parents' practices and attitudes regarding eye care were also assessed within the questionnaire.

RESULTS

The study included 899 parents who replied to the online questionnaire in its entirety. Some 54% of the responding parents were aged 30-50 years, and 51.2% were males. Of the parents, 46.2% had a university-level education, and 48.5% accompanied their children for eye examinations. About 65% of the parents knew about clinics for eye examinations, and 63.3% of them knew that blind children could learn. In total, more than one-third of the parents were aware of pediatric eye care.

CONCLUSIONS AND RECOMMENDATIONS

The study found that parents were aware of pediatric eye health and sought eye care for their children. More effort should be put forth through planned awareness programs to educate parents and assist them in overcoming the fears and barriers that keep them from seeking eye care for their children.

The Vision Detroit Project: Integrated Screening and Community Eye-Health Education Interventions Improve Eyecare Awareness

PURPOSE

Poor eye-health knowledge and health literacy are pervasive, contributing to worse outcomes. This study aims to examine short- and long-term eye-health knowledge retention following eye-health education interventions in adults.

METHODS

Vision Detroit was an outreach vision screening program that integrated a 5-Point Teaching Intervention (5PTI), at a Southwest Community Center (SW-CC) from 2015-2017. The 5PTI consists of eye-health learning points developed to verbally educate patients. During vision screenings, eye-health knowledge tests were administered before and after 5PTI (Test 1 and Test 2, respectively). In 2016, Community Eye-Health Education Interventions (CHEI) were initiated at the SW-CC. During CHEI, bilingual healthcare students taught voluntary SW-CC members the 5PTI learning points, regardless of participant interest to attend future screenings. CHEI sessions occurred on separate dates prior to vision screening events. Test 1 and Test 2 scores were compared for all participants. Test 1 scores were compared for those who underwent CHEI prior to vision screening (CHEI positive) versus those who did not (CHEI negative).

RESULTS

Two-hundred-seventeen adult patients met inclusion criteria, with 75.8% women, 82.6% Hispanic, mean age 50.4 ± 16.2 years, 74.6% had high school or less education, and 49.2% had health insurance. Test 1 to Test 2 scores improved after 5PTI (71.2 ± 26.4% vs. 97.2 ± 9.9%, p < .00001). Forty-eight participants attended CHEI and subsequent vision screening. Test 1 scores were higher among those CHEI positive versus CHEI negative (81.1 ± 2.1% vs. 68.3 ± 3.4%, p = .0027).

CONCLUSION

Simple eye-health education interventions, delivered during vision screenings and via community-based education, can improve eye-health knowledge.

Appropriateness of Antibiotic Prescribing for Acute Conjunctivitis: A Cross-Sectional Study at a Specialist Eye Hospital in Ghana, 2021

Most presentations of conjunctivitis are acute. Studies show that uncomplicated cases resolve within 14 days without medication. However, antibiotic prescription remains standard practice. With antimicrobial resistance becoming a public health concern, we undertook this study to assess antibiotic prescription patterns in managing acute conjunctivitis in an eye hospital in Ghana. We recorded 3708 conjunctivitis cases; 201 were entered as acute conjunctivitis in the electronic medical records (January to December 2021). Of these, 44% were males, 56% were females, 39% were under 5 years, 21% were children and adolescents (5-17 years) and 40% were adults (≥18 years). A total of 111 (55.2%) patients received antibiotics, of which 71.2% were appropriately prescribed. The use of antibiotics was more frequent in children under 17 years compared to adults (p < 0.0001). Of the prescribed antibiotics, 44% belonged to the AWaRe "Access" category (Gentamycin, Tetracycline ointment), while 56% received antibiotics in the "Watch" category (Ciprofloxacin, Tobramycin). Although most of the antibiotic prescribing were appropriate, the preponderance of use of the Watch category warrants stewardship to encompass topical antibiotics. The rational use of topical antibiotics in managing acute conjunctivitis will help prevent antimicrobial resistance, ensure effective health care delivery, and contain costs for patients and the health system.

The effect of eye care protocol on the prevention of ocular surface disorders in patients admitted to intensive care unit

Eye care is one of the most critical tasks of intensive care unit (ICU) nurses. Patients in this unit are exposed to potential ocular problems due to critical conditions. This study aimed to establish a new eye care protocol for preventing ocular surface disorders in patients admitted to ICU. This was a clinical trial study performed on patients admitted to ICU in 2019. The data gathering tools included the demographic questionnaire, the Schirmer test for dry eye, fluorescein staining and slit lamp manual for examining corneal ulcers, and slit lamp manual to check keratitis and conjunctivitis. A type of eye care protocol was performed on the patient's eyes. After five consecutive days of executing the protocol, the data were analyzed using SPSS software version 18. The use of eye care protocol reduced the risk of keratitis (P=0.027), conjunctivitis (P=0.012), eye dryness (P=0.001), and corneal ulcer (P=0.003) in patients admitted to ICU in the intervention group compared to the control group. Ophthalmology protocols reduced the incidence of keratitis, conjunctivitis, dry eye, and corneal ulcers in ICU patients. Therefore, using this method in ICU patients can improve nursing care.

The Role of Village Doctors in Residents' Uptake of Eye Screening: Evidence from Ageing Residents in Rural China

The lack of formal eye screening is the main reason for insufficient eye care utilization in rural China. Cataract, in particular, is increasingly prevalent with the aging population, but the treatment rate is relatively low. Village doctors are the most accessible health care resource for rural residents, receiving few empirical investigations into their role in eye care. This study aims to assess the role of village doctors in residents’ uptake of eye screening (vision and cataract screening), the first step of cataract treatment. Data come from a community-based, cross-sectional survey conducted in 35 villages of a county of the Gansu Province, Northwestern China, in 2020. Among 1010 residents aged ≥ 50 and 35 village doctors, the multivariate logistic regression shows that village doctors’ age, time spent on public health service, and service population were positively associated with residents’ uptake of vision and cataract screening. Village doctors were capable of playing an active role in primary eye health services due to their richer knowledge about cataracts than residents (accuracy rate 86.75% vs. 63.50%, p < 0.001), but less than half of them were willing to undertake eye screening. This study highlights the positive role of village doctors in aging residents’ eye screening and the potential role in improving the uptake of eye screening by offering health education.

Providing vouchers and value information for already free eye exams increases uptake among a low-income minority population: A randomized trial

We study whether vouchers without and with value information encourage attendance of already free follow-up appointments among low-income minority individuals referred for evaluation of possible eye disease. Between May 2017 and September 2018, 821 individuals referred from 114 screening events across Baltimore City were offered (1) standard referral for a free follow-up appointment and prescription glasses, (2) a paper voucher described as redeemable for free follow-up and prescription glasses, or (3) an otherwise identical paper voucher which also indicated the monetary value of the appointment ($250). Under all three conditions, all referred individuals received the same patient education, counseling, and appointment reminders. We find that vouchers without and with value information increase follow-up by 12.5 and 20.3 percentage points, respectively, corresponding to a 36% and 58% increase compared to the standard referral for free follow-up (i.e., without a voucher). We conclude that using vouchers is a promising, low-cost approach to increase uptake of already free health services, particularly when the vouchers also provide value information.

Community Eye Care Outreaches through Collaborations with Community-Based Organisations in Resource-Poor Settings in Ilorin, Nigeria

BACKGROUND

The access to universal eye health is still poor in many developing countries. There are various initiatives to address this problem, but the initiatives are majorly under the support of external funding. This study reports community outreaches supported by community-based organisations over a 7-year period in resource-poor settings in Ilorin, Kwara State, Nigeria.

AIMS AND OBJECTIVES

This study aims to describe the processes/procedures, output, and funding of eye care services provided in the rural communities over a 7-year period. The study seeks to present the process, demographical profiles, disease pattern, challenges, and recommendation in finding the core area of development to improving eye care services for these communities as well. The setting of this research work is 65 rural communities around the Ilorin metropolis of Kwara State, Nigeria. The design of the study is a retrospective review.

MATERIALS AND METHODS

This is a descriptive study of 7-year community eye outreaches in Ilorin, Nigeria. Data were analysed with IBM-Statistical Package for Social Sciences (SPSS-20).

RESULTS

A total of 65 communities with 235 visits were carried out between the years 2013 and 2019, with a total of 13,661 persons screened. The major eye diseases seen were refractive errors, allergic conjunctivitis, cataract, and pterygium. Common surgical eye problems were cataract, pterygium, and glaucoma. Community-based organisation direct financial support built up from USD 855 in 2013 and totalled USD 27,250 in 2019. Community-based organisation funding is an alternative and useful means of meeting the unmet needs of eye care in resource-poor communities. Subsidised care was provided to community-sourced patients due to support by local community-based organisations. This subsidy assisted in reaching the outreach numerical goal. However, it was still inadequate to meet the total needs as seen by the lower number of clinical care and surgeries rendered against the total numbers identified.

CONCLUSION

To achieve sustainable and wider coverage of care, a combination of local source and external funding is required. This study shows that community eye care programme can be supported by local or indigenous sponsors in a sustainable manner, thereby contributing considerably to addressing prevalent cases of avoidable blindness.

Diabetic retinopathy awareness and eye care behaviour of indigenous women in Saskatoon, Canada

Diabetes is a public health challenge in Canada with a disproportionate number of Indigenous people, especially women, living with diabetes. Diabetic retinopathy is a diabetes ocular complication and a common cause of blindness in Canadian adults. Many individuals living with diabetes do not have regular diabetic eye screening. This study sought to determine the diabetic retinopathy awareness and eye care behaviour of Indigenous women with diabetes or at risk of diabetes. This was a quantitative study among 78 Indigenous women (First Nations and Métis) in Saskatoon, Canada. Data on diabetic retinopathy awareness and eye care behaviour were collected via a knowledge, attitude, and practice survey. Participants had high diabetic retinopathy practice mean scores (32.16) than knowledge (30.16) and attitude scores (22.56). Sub-group analysis showed a significant difference in knowledge scores between age, education, and diabetes status, and differences in practice scores between age and education. Although our regression analysis indicated an association between education and knowledge scores (p = 0.024), and diabetes status and attitude scores (p = 0.044), the associations are not conclusive. Indigenous peoples with or at risk of diabetes may benefit from targeted interventions on diabetes and eye care, which could improve eye care awareness and behaviour.

Ophthalmology practice during COVID-19 pandemic: A survey of Indian ophthalmologists

Purpose

To assess the ophthalmic practice pattern among ophthalmologists in India amidst the COVID-19 pandemic.

Methods

An online questionnaire-based analysis was performed among members of the All India Ophthalmological Society (AIOS) and results were analyzed using SPSS software version 20.

Results

A total of 2253 responses were received. The majority of the participants (72.6%) were between 30 and 60 years of age and were into private practice (64.7%). During the lockdown, over one-third of participant ophthalmologists reported not attending any OPD patients, whereas a majority (64%) provided only emergency ophthalmic services. During the COVID-19 pandemic, <15% surgeries were performed compared to the pre-COVID-19 era by 81% of participants, whereas elective surgeries were performed by only 4.3%. The proportion of participants utilizing telemedicine in ophthalmology showed a two-fold rise from the pre-COVID-19 era (21.9%) to the COVID-19 pandemic (46%). Over half of the participants reported following the AIOS guidelines, reducing clinic hours, use of screening questionnaires, minimizing staff, and use of breath shield on a slit lamp as precautionary measures to reduce the exposure. Over 95% of ophthalmologists were satisfied (score > 5/10) by the AIOS guidelines for ophthalmic practice during COVID-19.

Conclusion

COVID-19 pandemic has adversely affected the ophthalmic care services across India with telemedicine emerging as a major rescue. The majority of practicing ophthalmologists are satisfied with guidelines provided by AIOS for ophthalmic care during the COVID-19 pandemic and have implemented the same in their setup.

Multi-purpose Disinfecting Solutions only Partially Inhibit the Development of Ocular Microbes Biofilms in Contact Lens Storage Cases

PURPOSE

Certain ocular resident or pathogenic microbes may remain viable in the presence of multi-purpose disinfectant solutions (MPDSs), subsequently developing biofilms inside contact lens storage cases (CLSCs) which pose a risk of infection to wearers. This study evaluated the formation of ocular microbiota biofilms exposed to three top selling MPDS.

METHODS

Crystal violet assay was carried out for the verification of biofilm formation. The in vitro assays evaluated Pseudomonas aeruginosa UFPEDA 416 and Staphylococcus aureus UFPEDA 02 exposure of 48 h to MPDS, as well as the use of 40 KHz ultrasound at the beginning and with 24 h immersion in the MPDS. Subsequently, in vivo assays evaluated the formation of microbial biofilms on the CLSC walls containing silicone-hydrogel contact lenses immersed in MPDS from 15 healthy volunteer patients, who had been wearing the lenses for 7 days.

RESULTS

Biofilms were inhibited by 26%-98% in the in vitro assays, with a statistically significant difference only for P. aeruginosa UFPEDA 416 exposed to diluted MPDS. Most inhibitions occurred moderately and weakly. In addition, adherent cells were detected in more than 90% of the tests. Biofilm was not inhibited in more than one third of the results, nor was it disturbed, especially with the ultrasound treatments. The average of obtained optical densities at 590 nm was between 0.6 and 0.8 in the in vivo assays. The results were similar between the CLSC right and left wells. There was a correlation between microbial biofilm formation and the type of MPDS tested, with statistical difference between the three treatments.

CONCLUSION

MPDS promoted a partial inhibition of microbial biofilm formation but only one MPDS proved to be more effective in vitro and in vivo. This study, however, could not distinguish the effect of possible errors in the good hygiene practices of the users.

Recommendations for ophthalmologic practice during the easing of COVID-19 control measures

In the context of the COVID-19 pandemic, this paper provides recommendations for medical eye care during the easing of control measures after lockdown. The guidelines presented are based on a literature review and consensus among all Spanish Ophthalmology Societies regarding protection measures recommended for the ophthalmologic care of patients with or without confirmed COVID-19 in outpatient, inpatient, emergency and surgery settings. We recommend that all measures be adapted to the circumstances and availability of personal protective equipment at each centre and also highlight the need to periodically update recommendations as we may need to readopt more restrictive measures depending on the local epidemiology of the virus. These guidelines are designed to avoid the transmission of SARS-CoV-2 among both patients and healthcare staff as we gradually return to normal medical practice, to prevent postoperative complications and try to reduce possible deficiencies in the diagnosis, treatment and follow-up of the ophthalmic diseases. With this update (5th ) the Spanish Society of Ophthalmology is placed as one of the major ophthalmology societies providing periodic and systematized recommendations for ophthalmic care during the COVID-19 pandemic.

Risk Factors of Eye Complications in Patients Treated in the Intensive Care Unit

In critically ill patients, normal eye protection mechanisms, such as tear production, blinking, and keeping the eye closed, are impaired. In addition, many other factors related to patients' severe condition and treatment contribute to ocular surface disease. Reducing risk factors and proper eye care can have a significant impact on incidences of eye complications and patient quality of life after discharge from the intensive care unit (ICU). The aim of the study was to determine risk factors for ocular complication, especially those related to nursing care. The study was conducted in the ICU of a university hospital. Methods for estimating and analyzing medical records were used. The patient's evaluation sheet covering 12 categories of risk factors for eye complications was worked out. The study group included 76 patients (34 patients with injuries and 42 without injuries). The Shapiro-Wilk test, the Spearman's rank correlation test, the Mann-Whitney U test and the Friedman's ANOVA test were used. The level of significance was set at α = 0.05. The most important risk factors for eye complications in the study group were: lagophthalmos (p < 0.001), sedation (p < 0.01), use of some cardiological drugs and antibiotics (p < 0.01), mechanical ventilation (p < 0.05), use of an open suctioning system (p < 0.01), presence of injuries (p < 0.01) including craniofacial trauma (p < 0.001), high level of care intensity (p < 0.01), failure to follow eye care protocol (p < 0.001), length of hospitalization at the ICU (p < 0.001), and the frequency of ophthalmological consultations (p < 0.001). There was no correlation between the incidence of these complications and the age and gender of the patients. The exposure of critically ill patients to eye complications was high. It is necessary to disseminate protocols and guidelines for eye care in ICU patients to reduce the risk factors.

Exploring the barriers for eye care among transgenders and commercial sex workers in Pune, Maharashtra

Purpose

To explore all possible barriers faced by transgenders (TG) and commercial sex workers (CSW) in accessing eye care in Pune city in western India.

Methods

This qualitative study was conducted at a tertiary eye care center in Pune. Interview topic guides for face-to-face interviews and focused group discussions were developed. Comprehensive eye check-up was organized in the residential localities of TG and CSW communities in Pune. Those with severe visual impairment or blindness were identified. A sample of TGs and CSWs from this group was purposively selected and invited to participate in this study. Face-to-face interviews were conducted with each TG and CSW. A group of health care providers and NGO workers serving these communities were invited to participate in focused group discussions. All interviews/discussions were audio recorded, transcribed, and translated into English. A qualitative software (N vivo 12, QRS International, Australia) was used to identify various themes and subthemes under each domain of barriers.

Results

A total of 24 people (6 each from TGs, CSWs, health care provider, and NGO worker groups) participated in this study. The most common barriers reported were social stigma, discrimination, poverty, financial exclusion, and mental health factors. Non availability of gender-neutral facilities in clinics was a unique barrier reported by TGs.

Conclusion

Marginalized communities of TGs and CSWs in Pune face several previously unexplored and unique barriers for access to eye care despite the availability of services in the vicinity.

Eye health profile of affordable eye care service users

CLINICAL RELEVANCE

Knowledge of the typical eye health profile of patients experiencing social or economic disadvantage is useful for health care modelling.

BACKGROUND

The aim of this work is to profile the ocular health and sociodemographic characteristics of Australian College of Optometry service users of all ages and to explore the relationships between key sociodemographic characteristics and eye health.

METHODS

For 3093 eye examinations, best-corrected distance visual acuity and mean spherical equivalent refractive error were tested non-parametrically by clinic category, remoteness area, number of co-morbidities, gender and indigenous status, also correlated against age and socioeconomic advantage/disadvantage. Covariates of interest were entered into linear mixed models of visual acuity and mean spherical equivalent refractive error, controlling for age. Risk estimates are reported for visual impairment (defined as ≤6/12 best-corrected distance visual acuity in one or both eyes) and ocular diagnoses.

RESULTS

Visual impairment is more prevalent amongst service users examined in domiciliary settings. Increasing co-morbidities were associated with poorer best-corrected distance visual acuity. Aboriginal and Torres Strait Islander service users had lower visual impairment prevalence overall but proportionally fewer aged ≥50 years attended for eye care, compared to non-indigenous.

CONCLUSIONS

Domiciliary eye examinations detect remediable visual impairment. Federal public health interventions delivered by the Australian College of Optometry for Aboriginal and Torres Strait Islander eye care appear effective but may not reach all aged ≥ 50 years; further research is required. Identification of multiple co-morbidities should prompt optometrists to tailor public health messages and signpost to low vision services earlier.

Pseudoexfoliation and Cataract Syndrome Associated with Genetic and Epidemiological Factors in a Mayan Cohort of Guatemala

The Mayan population of Guatemala is understudied within eye and vision research. Studying an observational homogenous, geographically isolated population of individuals seeking eye care may identify unique clinical, demographic, environmental and genetic risk factors for blinding eye disease that can inform targeted and effective screening strategies to achieve better and improved health care distribution. This study served to: (a) identify the ocular health needs within this population; and (b) identify any possible modifiable risk factors contributing to disease pathophysiology within this population. We conducted a cross-sectional study with 126 participants. Each participant completed a comprehensive eye examination, provided a blood sample for genetic analysis, and received a structured core baseline interview for a standardized epidemiological questionnaire at the Salama Lions Club Eye Hospital in Salama, Guatemala. Interpreters were available for translation to the patients’ native dialect, to assist participants during their visit. We performed a genome-wide association study for ocular disease association on the blood samples using Illumina’s HumanOmni2.5-8 chip to examine single nucleotide polymorphism SNPs in this population. After implementing quality control measures, we performed adjusted logistic regression analysis to determine which genetic and epidemiological factors were associated with eye disease. We found that the most prevalent eye conditions were cataracts (54.8%) followed by pseudoexfoliation syndrome (PXF) (24.6%). The population with both conditions was 22.2%. In our epidemiological analysis, we found that eye disease was significantly associated with advanced age. Cataracts were significantly more common among those living in the 10 districts with the least resources. Furthermore, having cataracts was associated with a greater likelihood of PXF after adjusting for both age and sex. In our genetic analysis, the SNP most nominally significantly associated with PXF lay within the gene KSR2 (p < 1 × 10⁻⁵). Several SNPs were associated with cataracts at genome-wide significance after adjusting for covariates (p < 5 × 10⁻⁸). About seventy five percent of the 33 cataract-associated SNPs lie within 13 genes, with the majority of genes having only one significant SNP (5 × 10⁻⁸). Using bioinformatic tools including PhenGenI, the Ensembl genome browser and literature review, these SNPs and genes have not previously been associated with PXF or cataracts, separately or in combination. This study can aid in understanding the prevalence of eye conditions in this population to better help inform public health planning and the delivery of quality, accessible, and relevant health and preventative care within Salama, Guatemala.

Assessment of Patients' Confidence Regarding a New Triage Concept in a Medical Retina Clinic during the First COVID-19 Outbreak

BACKGROUND

During the first COVID-19 pandemic outbreak, a new triage concept had to be implemented for patients with retinal diseases having a scheduled appointment at the medical retina clinic. In this study, we aimed to assess patients' confidence in this triage concept and patients' satisfaction regarding the received treatment during the outbreak.

METHODS

This retrospective study included all patients with a diagnosed retinal disease, triaged into three priority groups based on their condition's urgency during lockdown. After restrictions were eased, a subset of previously triaged patients was interviewed to assess their confidence in the triage and their satisfaction regarding the received treatment during the pandemic.

RESULTS

In total, 743 patients were triaged during the lockdown. Over 80% received an urgent appointment (priority 1). Among all priority 1 patients, over 84% attended their appointment and 77% received an intravitreal injection (IVI), while 7% cancelled their appointment due to COVID-19. In post-lockdown interviews of 254 patients, 90% trusted the emergency regimen and received treatment.

CONCLUSIONS

Our triage seemed to be useful in optimizing access to treatment for patients with retinal diseases. An excellent rating of patients' confidence in the triage and satisfaction regarding the received treatment during the first COVID-19 outbreak could be achieved.

Facilitators and barriers to the delivery of eye care by optometrists: a systematic review using the theoretical domains framework

PURPOSE

Evidence-based practice is fundamental to providing quality care, patient satisfaction and judicious use of limited healthcare resources. However, variability in evidence-based eye care delivery has been reported. Given the important role of optometrists in delivering primary eye care, a better understanding of the barriers and facilitators to providing optometric care is required. This systematic review aimed to identify determinants (barriers and facilitators) of eye care delivery by optometrists and interventions that may improve eye care delivery.

RECENT FINDINGS

PubMed, MEDLINE, EMBASE, CINAHL, SCOPUS, PsychINFO, ProQuest and Web of Science were searched for studies reporting barriers and facilitators to eye care delivery published between 1999 and 2020. The Theoretical Domains Framework (TDF) was used to analyse data (quotations, interpretive summaries, survey result) with barriers and facilitators coded to one or more of the 14 domains, and used to identify the key behavioural domains influencing eye care delivery based on frequency of coding, elaboration and stated importance in the study. Influential domains were mapped to the Behaviour Change Wheel to identify potential interventions to improve eye care delivery. Of the 802 studies retrieved from the search, 30 were included. Frequently identified barriers were time constraints, resources and equipment issues, patient factors, lack of awareness, skill proficiency deficits and negative attitudes and beliefs. Frequently identified facilitators were adequate time, resources and equipment, education, skill proficiency and understanding the relevancy of the eye care provided. The key TDF domains influencing eye care delivery were 'environmental context and resources' (time, resources, equipment issues, patient factors), 'knowledge' (awareness issues), 'skills' (skills proficiency) and 'belief about consequences' (beliefs and relevancy). Intervention functions that may improve eye care delivery were education, training, restriction, environmental restructuring, enablement, persuasion and modelling.

SUMMARY

The barriers and facilitators identified in this review were diverse and located at both the practitioner and organisational levels. Four TDF domains were found to be influential determinants of eye care practice. Intervention functions identified in this study can be used to improve the appropriateness of primary eye care delivery.

Training results in increased practitioner confidence and identification of depression in people with low vision: a mixed methods study

PURPOSE

The prevalence of depression in people with low vision is high and often goes undiagnosed. There is the potential for those who provide low vision services to perform concurrent depression screening. However, prior training in depression identification and suitable referral pathways is required. The aims of this study were: (1) to assess the impact of a training programme on practitioners' confidence and behaviour in addressing depression in patients with low vision, and (2) to review the training programme and identify areas for further development.

METHODS

A convergent mixed methods approach was used. Questionnaires were completed by practitioners pre-, immediately post- and 6 months post- training (n = 40) to assess practitioner confidence in approaching depression in patients with low vision. Qualitative interviews were performed with a subset of practitioners 6 months post-training (n = 9). Additionally, routine data from the Low Vision Service Wales (LVSW) database was used to determine the change in the number of practitioners identifying depression in patients, and the change in the number of patients identified at risk of depression 6 months post-training.

RESULTS

Of the 148 practitioners who completed low vision assessments pre- and post-training, 28 (18.9%) documented risk of depression in their patients pre-training, which increased substantially to 65 (43.9%) post-training (p < 0.0001). Mixed methods analysis confirmed increased documentation of depressive symptoms by practitioners. Practitioner confidence increased following training, with 92.3% feeling more confident to approach emotional issues with patients and 92.2% intending to use the recommended screening tool to identify depression. Interviews provided insight into areas where confidence was still lacking. Quantitative questionnaires revealed that training content was considered appropriate by 91% of participants. Interviews confirmed these findings while expanding upon possibilities for programme improvement.

CONCLUSIONS

Training for depression screening was found to be time-efficient and acceptable for LVSW practitioners and shown to increase practitioner confidence in the identification of depression. Additionally, the programme changed behaviour, resulting in an increase in the identification of depression in patients with low vision. However, this is a complex topic and ongoing development is required to embed depression screening as an integral part of low vision services.

Low rates of eye care utilization among visually impaired subsidized senior housing residents

OBJECTIVE

To examine the rate of self-reported vision impairment, eye disease, and eye care utilization among residents of subsidized senior housing (SSH) communities.

METHODS

In this cross-sectional, observational study, residents of 14 SSH communities in Jefferson County, AL, USA self-reported their vision status and eye care utilization as part of vision screening events held in their community.

RESULTS

Two hundred and thirty-seven residents self-reported their vision status, presence of eye disease, and eye care utilization. A third of participants (33.3%) reported difficulty with distance vision while 38% reported difficulty with near vision. Rates of eye disease among this sample were as follows: 40.3% reported having cataracts, 13.6% reported having glaucoma, 4.2% reported having age-related macular degeneration, and 5.5% reported having diabetic retinopathy. The majority of participants (52.8%) had not been to see an eye care provider within the last year. Persons with vision impairment were less likely to report having seen an eye care provider within the last year than those without impairment (p = .03).

CONCLUSION

This study illuminates the low utilization of eye care among socioeconomically disadvantaged older adults residing in SSH, especially among those with vision impairment and eye disease. Vision-related health care is important in maintaining both physical and mental health in older adults.

Response of L V Prasad Eye Institute to COVID-19 outbreak in India: experience at its tertiary eye care centre and adoption to its Eye Health Pyramid

AIM

To summarize the experience of response to COVID-19 outbreak at a tertiary eye care institute and its network of health facilities in India.

METHODS

Our responses are based on the principles of social distancing, hand hygiene, respiratory etiquettes, surface disinfection protocol, and rational use of appropriate personal protective equipment (PPE). We describe our response in terms of administrative controls, clinical protocols, staff protection, environmental controls, and social distancing measures. We also discuss our communication strategies and monitoring systems, to ensure compliance to protocols.

RESULTS

Administrative control is mainly related to formation of task force and its functions. Clinical protocols are related to patient triaging methods and clinical examination guidelines in Outpatient, Inpatient and Operating Room. Staff protection is focused on training staff on the protocols to be followed in hospital as well as at home, and use of PPE. Environmental protocol is focused on cleaning and disinfectant methods to be used in the hospital. In addition, there are systems for communication as well as monitoring compliance to protocols.

CONCLUSION

We hope that these protocols and our experience would help the ophthalmic community globally and serve as a guide to protect ophthalmologists and ophthalmic care personnel, and their patients across the world.

A model of culturally-informed integrated diabetes education and eye screening in indigenous primary care services and specialist diabetes clinics: Study protocol

AIMS

To improve diabetes management in Indigenous Australians using an integrated nurse-led model of diabetes education and eye screening in indigenous primary care and specialist diabetes clinics.

DESIGN

A pre-post study.

METHODS

This study will be implemented in indigenous primary care and specialist diabetes clinics in Victoria, Australia. Participants recruited to the study will be existing adult patient with diagnosed diabetes attending study sites. A nurse-credentialled diabetes educator and certified retinal imager will deliver three study components: (a) retinal photography as a diabetic retinopathy screening and patient engagement tool; (b) lifestyle and behaviour surveys, administered at baseline and at the final visit, in 12 months. Findings from the surveys and participants' retinal images will be used to guide; and (c) personalized diabetes education. The primary outcomes are participant adherence to diabetic eye screening recommendations and health service diabetic retinopathy screening coverage. Secondary outcomes are baseline DR prevalence and changes in clinical and lifestyle risk factor levels, diabetes knowledge and satisfaction with diabetes care.

DISCUSSION

Compared with non-indigenous Australians, Indigenous Australians have a high prevalence of diabetic retinopathy and blindness, low adherence to eye screening recommendations and suboptimal health literacy. Nurse-credentialled diabetes educators can be trained to incorporate retinal imaging and eye screening into their clinical practice to give image-based diabetes education to facilitate diabetic retinopathy management.

IMPACT

Credentialled nurse diabetes educators who integrate eye screening and diabetes education can facilitate timelier diabetic retinopathy screening, referral pathways and treatment of sight-threatening retinopathy. We believe that this model of integrated diabetes education and eye screening will also improve adherence to eye screening recommendations, population screening coverage, health literacy, risk factor levels and diabetes self-care.

CLINICAL TRIAL REGISTRATION

ANZCTRN1261800120435.

Cataract Surgery Complexity and Surgical Complication Rates Among Medicare Beneficiaries With and Without Dementia

PURPOSE

To evaluate cataract surgery complexity and complications among US Medicare beneficiaries with and without dementia.

DESIGN

Retrospective claims-based cohort study.

PARTICIPANTS

A 20% representative sample of Medicare beneficiaries, 2006-2015.

METHODS

Dementia was identified from diagnosis codes on or prior to each beneficiary's first-eye cataract surgery. For each surgery, we identified setting, routine vs complex coding, anesthesia provider type, duration, and any postoperative hospitalization. We evaluated 30- and 90-day complication rates-return to operating room, endophthalmitis, suprachoroidal hemorrhage, retinal detachment, retinal tear, macular edema, glaucoma, or choroidal detachment-and used adjusted regression models to evaluate likelihood of surgical characteristics and complications. Complication analyses were stratified by second-eye cataract surgery within 90 days postoperatively.

RESULTS

We identified 457,128 beneficiaries undergoing first-eye cataract surgery, 23,332 (5.1%) with dementia. None of the evaluated surgical complications were more likely in dementia-diagnosed beneficiaries. There was also no difference in likelihood of nonambulatory surgery center setting, anesthesiologist provider, or postoperative hospitalization. Dementia-diagnosed beneficiaries were more likely to have surgeries coded as complex (15.6% of cases vs 8.8%, P < .0001), and surgeries exceeding 30 minutes (OR = 1.21, 95% CI = 1.17-1.25).

CONCLUSIONS

Among US Medicare beneficiaries undergoing cataract surgery, those with dementia are more likely to have "complex" surgery" lasting more than 30 minutes. However, they do not have greater likelihood of surgical complications, higher-acuity setting, advanced anesthesia care, or postoperative hospitalization. This may be influenced by case selection and may suggest missed opportunities to improve vision. Future research is needed to identify dementia patients likely to benefit from cataract surgery.

Visual Status in a Portuguese Population with Intellectual Disability

BACKGROUND

Neurosensory deprivation associated with vision is a well-known fact in people with intellectual disability (ID). This work aims to report the visual status of a population with ID in Portugal.

METHODS

A vision screening protocol was conducted during two Special Olympics events. The vision protocol included personal medical history, ocular health evaluation, and clinical measures, such as visual acuity (VA), binocular vision, colour vision, refractive error, and intraocular pressure. This protocol was administered to 134 subjects.

RESULTS

Half of the subjects reported that they had never attended or they did not remember having attended a previous eye exam. Additionally, 10% of them had not attended an eye exam in the immediate past three years. Half the subjects failed the VA test and 13% presented moderate Visual Impairment (VI) (VA worse than 0.5 logMAR in the best eye). Manifest ocular deviation was found in 25% of the subjects and the most common ocular health dysfunction conditions were conjunctiva hyperaemia, meibomian gland dysfunction, and lens anomalies. Refractive error correction allowed a reduction in the level of moderate VI to 3.7%.

CONCLUSIONS

The population analysed showed a poor eye care attendance rate and vision-related conditions are in agreement with previous reports. The development of national strategies to promote the awareness for routine eye care in people with ID and improving accessibility to eye care services may mitigate many of the most prevalent conditions encountered.

Descemetocele and bilateral, severe Pseudomonas keratitis in an intensive care unit patient with Graves' orbitopathy: A case report

RATIONALE

Exposure keratopathy (EK) is common among intensive care unit (ICU) patients, especially those under sedation and with incomplete eyelid closure. EK can be mild punctate epithelial erosions exhibiting spontaneous recovery; rarely, severe complications including bacterial ulcers causing corneal perforation or opacity could occur. We describe a patient with pre-existing Graves' orbitopathy (GO) who developed bilateral, rapidly progressing bacterial keratitis due to EK with secondary aerosol inoculation from respiratory pathogens in ICU.

PATIENT CONCERNS

A 49-year-old intubated and sedated woman who underwent urgent craniotomy was admitted to ICU. The ophthalmology department was consulted for progressive chemosis. History of poorly controlled GO was revealed based on external ocular signs, including proptosis with lid retraction, and careful ophthalmological history taking. After 2 days of ICU admission, slit lamp examination revealed large inferior corneal epithelial defects and dellen (OU). Despite prescribing gentamicin ointment and lubricants, purulent discharge with corneal infiltration and thinning (OU) was observed 2 days later. Owing to a characteristic Pseudomonas odor from her endotracheal tube, corneal and endotracheal sputum cultures were obtained, which revealed Pseudomonas aeruginosa infection.

DIAGNOSIS

Pseudomonas keratitis secondary to EK INTERVENTIONS:: Topical fortified anti-Pseudomonas antibiotic eye drops with temporary tarsorrhaphy and lubricants OUTCOMES:: Despite multiple treatments, she developed enlarging descemetocele in the left eye with severe corneal stromal destruction and severe visual impairment due to central corneal scar formation in the right eye. After 2 months, the descemetocele ruptured owing to generalized tonic-clonic seizures after cranioplasty. Therefore, she underwent urgent penetrating keratoplasty in the left eye.

LESSONS

GO increases ocular surface inflammation and exposure, which may exacerbate EK and subsequent complication risks. Careful monitoring and aggressive treatment through appropriate eye care regimen are required in these patients.

Ocular Complications in the Prone Position in the Critical Care Setting: The COVID-19 Pandemic

PURPOSE

Ocular complications are common in the critical care setting but are frequently missed due to the focus on life-saving organ support. The SARS-CoV-2 (COVID-19) pandemic has led to a surge in critical care capacity and prone positioning practices which may increase the risk of ocular complications. This article aims to review all ocular complications associated with prone positioning, with a focus on challenges posed by COVID-19.

MATERIALS AND METHODS

A literature review using keywords of "intensive care", "critical care", "eye care", "ocular disorders", "ophthalmic complications," "coronavirus", "COVID-19," "prone" and "proning" was performed using the electronic databases of PUBMED, EMBASE and CINAHL.

RESULTS

The effects of prone positioning on improving respiratory outcomes in critically unwell patients are well established; however, there is a lack of literature regarding the effects of prone positioning on ocular complications in the critical care setting. Sight-threatening ophthalmic disorders potentiated by proning include ocular surface disease, acute angle closure, ischemic optic neuropathy, orbital compartment syndrome and vascular occlusions.

CONCLUSIONS

COVID-19 patients may be more susceptible to ocular complications with increased proning practices and increasing demand on critical care staff. This review outlines these ocular complications with a focus on preventative and treatment measures to avoid devastating visual outcomes for the patient.

Receipt of Eye Care Services among Medicare Beneficiaries with and without Dementia

PURPOSE

To examine the relationship between dementia status and receipt of eye care among US Medicare beneficiaries.

DESIGN

Retrospective, claims-based analysis.

PARTICIPANTS

A 20% representative sample of Medicare beneficiaries who received care between January 1, 2006, and December 31, 2015.

METHODS

Dementia was identified from diagnosis codes documented in a beneficiary's first 3 years of observed Medicare enrollment. Eye care visits were identified from provider specialty codes on each encounter claim. We used multivariable Cox proportional hazards regression models with time-varying covariates to compare the likelihood of receiving eye care between beneficiaries with and without dementia. All models were adjusted for potential confounders, including demographics, urban/rural residence, systemic health (Charlson Index), and ocular comorbidities.

MAIN OUTCOME MEASURES

Hazard ratio (HR) and 95% confidence interval (CI) for (1) being seen by any eye care provider (ophthalmologist or optometrist); (2) being seen by an ophthalmologist specifically; and (3) receiving cataract surgery (among beneficiaries with ophthalmologist encounters).

RESULTS

A total of 4 451 200 beneficiaries met inclusion criteria; 3 805 718 (85.5%) received eye care during the study period, and 391 556 (8.8%) had diagnosed dementia. Some 73.4% of beneficiaries diagnosed with dementia saw an eye care provider during the study period and 55.4% saw an ophthalmologist versus 86.7% and 74.0% of beneficiaries, respectively, without dementia diagnoses. Compared with those without dementia diagnoses, beneficiaries with diagnosed dementia had lower likelihood of seeing any eye care provider (adjusted HR, 0.69; 95% CI, 0.69-0.70) and were less likely to see an ophthalmologist (adjusted HR, 0.55; 95% CI, 0.55-0.55). Among the subset of beneficiaries who did see ophthalmologists, those with diagnosed dementia were also less likely to receive cataract surgery than beneficiaries without diagnosed dementia (HR, 0.62; 95% CI, 0.62-0.63) and less likely to receive a cataract diagnosis (18% vs. 82%).

CONCLUSIONS

US Medicare beneficiaries diagnosed with dementia are less likely to receive eye care than those without diagnosed dementia. Depending on visual acuity and functional status, this may have implications for injury prevention, physical and cognitive function, and quality of life. Further work is needed to identify barriers to receiving eye care, determine eye care services and settings that provide greatest value to patients with dementia, and implement measures to improve access to appropriate eye care.

Demographics and clinical presentation of patients with ocular disorders during the COVID-19 lockdown in India: A report

Purpose:

The aim of this study is to describe the demographics and clinical profile of patients with ocular disorders presenting during the novel coronavirus (COVID-19) lockdown in India.

Methods:

This cross-sectional hospital-based study included patients presenting between March 23, 2020 and April 19, 2020. All patients who presented to the emergency department were included as cases. The data were collected using an electronic medical record system.

Results:

Overall, 1,192 patients (mean 42.57 per day) presented to the ocular emergency department and were included for analysis. The median age of the patients was 35 (Interquartile range, IQR: 20-52) years and they were mostly adults (77.85%). The majority of patients were male (62.16%) and presented from the local metropolitan region (56.21%). On triaging based on the ocular disorders at presentation, the majority of the patients were emergency related (65.02%), followed by urgent (8.14%) and routine (26.85%) in nature. The most common emergencies were microbial keratitis (23.74%), followed by corneal trauma (16.39%). There was an increasing trend seen in emergency patients (46.11%; week 1 to 71.78%; week 4) and a decreasing trend seen in routine patients (45%; week1 to 21.20%; week 4). A subset of patients (23.49%) underwent surgery where indicated and the most commonly performed procedures were vitreo-retinal procedures (32.86%) followed by trauma related (31.43%).

Conclusion:

The enforcement of the nationwide lockdown due to COVID-19 resulted in a fewer patients presenting to the hospital. The majority of them presented from the local metropolitan region and the common emergencies were microbial keratitis and corneal trauma. About one fourth required a surgical intervention which was most commonly a vitreo-retinal procedure.

Evaluation of a pilot interprofessional Arclight™ workshop for healthcare students in Rwanda: promoting collaborative practice in eye health

Preventable and treatable visual impairment affects more than 1 billion people worldwide. Rwanda has an estimated visual impairment prevalence of 3.7% amongst the 12 million inhabitants. Around one third of this demand could be addressed through a more integrated and collaborative approach, particularly in primary eye care services. Healthcare students, therefore, need to be prepared for collaborative practice in eye health through interprofessional learning. Interprofessional workshops were piloted with ophthalmic clinical officer, medical clinical officer, nursing and medical students from the University of Rwanda. The aim was to promote collaborative practice by teaching students how to assess and recognize common eye conditions using the Arclight; a low cost, solar powered, portable ophthalmoscope designed for use in low resource settings. Students reported that the workshop content was relevant to all professional groups. They valued the opportunity to learn interprofessionally, share their knowledge and perspectives, and acquire new knowledge and skills together. This pilot helped to identify the most relevant skills and knowledge for future interprofessional eye health training. It enabled the facilitators to reflect on how best to maintain a balance between a quality interprofessional experience and the more specific eye health related learning objectives.