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The decision to have a routine eye examination involves individual- and service-level judgement. A deeper understanding of patient access barriers and expectations could facilitate the design of better-aligned service models in optometric practice, improving the utilisation rate of an important facet of primary healthcare services. Routine eye examinations achieve several health objectives, including mitigation of sight-threatening risk factors. However, there are barriers to service uptake. Through the qualitative approach, a deeper understanding of these barriers can be realised and enhanced strategies designed to improve the uptake of the routine eye examination. A qualitative study was conducted to identify the factors influencing the decision-making process of older adults to use the routine eye examination service. This study was guided by the grounded theory approach. Participants were purposively recruited from six community elderly centres. Semi-structured interviews were conducted with 25 community-dwelling adults aged 65 years or above in Hong Kong. Data were transcribed and constant comparison techniques were used for data analysis. Difficulty in prioritising and including the routine eye examination in the existing health service utilisation was the central theme associated with its lower use. Four sub-themes were identified to explain this phenomenon: (1) previous health care service utilisation as a reference for judging primary eye care; (2) low perceived primary eye care service needs; (3) low perceived self-efficacy on routine eye care utilisation; (4) service expectations. Multiple modifiable factors influence decision-making by older adults, suggesting that their routine eye care seeking behaviour might be altered through behaviour change intervention. The context in which services are delivered requires further study, with a focus on exploring the factors influencing service experience and its subsequent impact on regular eye care seeking behaviour. [ABSTRACT FROM AUTHOR]

Vision loss is a public health challenge adversely affecting over a billion people worldwide. Low and middle income countries (LMICs) have a disproportionately higher prevalence of vision loss compared to high-income countries. Over 80% of vision loss can be addressed with either spectacles or cataract surgery. Both of these interventions are low cost and cost effective. Despite this, several barriers prevent individuals from accessing eye care. This paper covers various elements of access (approachability, acceptability, affordability, availability and appropriateness) and presents barriers that prevent access to eye care services in LMICs. Disease-specific barriers and various models and strategies that address the accessibility challenges are presented with a special reference to the use of technology to improve access. Strategies such as providing free eye care, lowering direct and indirect costs, improve access to cataract surgery. While access-related challenges related to cataract surgery are well studied, there is inadequate information on access to refraction services for refractive errors and other conditions. Future research can focus on addressing this information gap. This can then help develop strategies to address the burden of uncorrected refractive errors and other causes of vision loss and contribute towards achieving universal eye health coverage. A literature search was carried out to identify the relevant articles reporting barriers to seeking eye care in the Medline, CINHAL and PsycINFO databases between 20 and 27 May 2023. From this search, the relevant articles were shortlisted for data extraction. [ABSTRACT FROM AUTHOR]

(1) To identify if adults with uncorrectable sight loss would increase their physical activity (PA) following advice from general healthcare, eyecare or sight loss service professionals. (2) To identify what resources could be provided alongside advice from a professional to facilitate PA. Survey data from 100 UK adults with uncorrectable sight loss were analysed. Adjusted logistic regression models were used to examine the association between participant characteristics, and the likelihood that participants would increase PA if advised to by different professionals. Most of our sample would increase their PA if advised to by a general practitioner (GP) (n = 78), ophthalmologist or optometrist (n = 70) or a low vision rehabilitation officer (n = 75). Thirty-one participants would increase their PA if advised to by a dispensing optician. Participants with a history of anxiety and depression were less likely to report they would increase their PA based on advice from a GP (p = 0.002). Sight loss specific and community-based PA groups, exercise specialist support, a sighted guide, and a travel plan, were considered by most participants to be useful facilitators of PA. The results suggest eyecare and sight loss service professionals could facilitate increases in PA among adults with sight loss. Physical activity levels among populations with sight loss are critically low, and inactivity increases the risk of chronic conditions and premature mortality within these populations. GPs, optometrists, ophthalmologists, or low vision rehabilitation officers could play a pivotal role in increasing physical activity levels among people with sight loss, by providing physical activity advice during consultations. Professionals advising people about physical activity should have the knowledge, and opportunity, to refer people with sight loss to accessible physical activity groups or services. [ABSTRACT FROM AUTHOR]

Children in socioeconomically disadvantaged communities often do not access follow-up eye care services when referred from vision screenings; whether this is due to lack of availability is not known. This paper highlights the need for vision and eye care for vulnerable children with practicing clinical optometrists well placed to provide vision care. Vision impairments develop from a young age and may inhibit learning experiences and impact life outcomes. Vision screening to detect and refer vision abnormalities supports children in their education and prevents minor vision impairments from worsening. This research describes outcomes from a vision screening programme for 4– to 5-year-olds delivered in Queensland, Australia. The programme involved all prep children from participating schools in Queensland. Vision screening was conducted with the Parr 4 m Visual Acuity Test and Welch Allyn Spot Vision Screener. A cross-sectional study design was adopted. Descriptive data analyses explored the frequency of vision screening and referral outcomes. Inferential analyses examined associations between vision screening and referral outcomes with socio-economic indexes for areas (SEIFA) scores. Of 71,003 prep students screened, 4,855 (6.8%) received a referral recommendation. A higher proportion of children who received a referral recommendation was from more disadvantaged locations (?2 = 109.16, p < 0.001). Of the students referred, 3,017 were seen by an eye health professional. Further vision assessment of students by an eye health professional revealed that 43.3% of the referred children were diagnosed with a vision abnormality, 18.9% had no vision abnormality and 37.7% had an 'undetermined' diagnosis. A higher proportion of children confirmed with a vision abnormality were from more disadvantaged locations (?2 = 52.27, p < 0.001). It is important that vision screening programmes target disadvantaged populations and support families of children who require further health assessment to access health services. [ABSTRACT FROM AUTHOR]

Homeless women are adversely affected by serious mental illness (SMI). More research is needed to address specific barriers they face to gaining access to mental healthcare and recommendations for effective mental health services. To address this gap in the literature, the present qualitative study was conducted with 13 homeless women with SMI using grounded theory methodology. Eight themes emerged from data analysis and included the following: Needing VIP Status (a challenge gaining access to healthcare which involves needing to have all documentation together and organized to access healthcare), Feeling Broken (when personal capacities are low and this limits access to healthcare), Soaring Above Rock Bottom (having a blissful feeling when accessing care after feeling at one's lowest), Whole Package Care (having all mental health and social care integrated within the same facility), Long Road to Care (having care for a long length of time helped the women in their recovery), Questions of Value (contributing their stories to research was important to the participants and may have increased their own value in their eyes), and Care that Feels Like Home (creating a welcoming home base in which to receive care was important for the women). Clinical and research implications are discussed. [ABSTRACT FROM AUTHOR]

Vision Bus Aotearoa is a fully equipped mobile eye health clinic designed to provide a novel platform for undergraduate optometry clinical training, community eye health research and deliver services to underserved communities. Aotearoa New Zealand has inequitable access to eye health care. Vision Bus Aotearoa aims to work in partnership with communities to provide comprehensive mobile primary eye health care services while training optometry students, and integrating community eye health research. A description is provided of the governance model which has been involved throughout the project. The process of vehicle manufacture, clinical set-up, funding models and service delivery are described. The aims of the project are detailed in terms of optometry teaching, clinical services in partnership with communities, and research integration and implementation. Vision Bus Aotearoa represents a valuable opportunity to deliver mobile eye health care to historically underserved communities, enhance undergraduate optometry teaching and to provide a unique platform for community eye health research. [ABSTRACT FROM AUTHOR]

Efforts to provide accessible eye care must consider the extent to which travel-distance may be a barrier for some communities. This study aimed to determine the distribution of — and geographic access to — eye health services in Aotearoa New Zealand. We further sought to identify communities who might benefit from provision of eye health services that were more geographically accessible. We obtained addresses of optometry and ophthalmology clinics from regulatory bodies and augmented this with online searches. Address locators were created using a Land Information dataset and geocoded using ArcGIS 10.6. A national population was derived using Statistics New Zealand's Integrated Data Infrastructure. We generated population-weighted centroids of each of New Zealand's 50,938 meshblocks and calculated the travel distance along the road network between each clinic and population (meshblock centroid). The proportion of the population living >50 km from each clinic type was calculated; as was the median, inter-quartile range and maximum distance across area-level deprivation quintiles in each district. A national population of 4.88 million was identified, as were addresses for 344 optometry, 46 public ophthalmology and 90 private ophthalmology clinics. Nationally and within each district, travel distance to optometry was shorter than to either type of ophthalmology clinic. The region of Northland — with a high proportion of the population Māori and in the highest quintile of area-level deprivation — had the furthest average distance to travel to optometry and public ophthalmology, while the West Coast region on the South Island had the farthest to travel to private ophthalmology. Several communities were identified where longer distances intersected with higher area-level deprivation. Most New Zealanders live within 10 km of eye health services. However, to achieve equitable eye health, strategies are required that make affordable eye health services accessible to communities for whom large travel distances intersect with high deprivation. [ABSTRACT FROM AUTHOR]

The key predictor variable for each model was whether the participant reported diagnosis of macular degeneration, diabetic retinopathy, glaucoma, or cataracts. In this study, we included adults (age>=40) who indicated having a previous diagnosis of ARMD, DR, glaucoma, or cataracts. [Extracted from the article]

Nunavik Inuit patients, in Northern Canada, have a significant burden of refractive error. The frequency at which they access eye care is insufficient. This exposes children of this population to a substantial risk of refractive amblyopia. No data are available on eye health and services among Nunavik Inuit in Quebec, Canada. This study aims to describe the prevalence of ametropias, risk of refractive amblyopia, and eye health services uptake amongst a sample of Nunavik Inuit. Retrospective cohort using data from electronic records of the sole government-contracted eye team travelling to all 14 Nunavik villages, from 2006 to 2018. Some 26,541 examinations were analysed, with data from 6,341 patients (median age 27 years (IQR 30); 32% aged under 19 years; 60.3% female) representing 48% of the census population. Population weighted prevalence of ametropias was myopia 46.5% (95% CI 45.3 – 47.6), hyperopia 17.1% (95% CI 16.2 – 18.1), astigmatism 39.6% (95% CI 38.4 – 40.8) and presbyopia 30.0% (95% CI 28.9 – 31.0). Some 5.9% of patients aged 0–9 years present a risk of refractive amblyopia. Mean frequency of examinations for all ages was once per 4 years (95% CI 4.0 – 4.0) and for children aged 5 – 19 years, frequency was once per 4.8 years (95% CI 4.8 – 5.0). In 2018, 74% of patients who were prescribed spectacles purchased them, with a median time of procurement of 21 days (IQR 247, skewness 2.7). There is a high prevalence of ametropias amongst the clinical population of Nunavik Inuit. Most patients needing spectacles obtain them within a few weeks. Frequency of eye health services is insufficient to meet recommended guidelines, especially in children, for whom the risk of refractive amblyopia is pervasive. [ABSTRACT FROM AUTHOR]

Keywords: Blindness; COVID-19; equity; eye health; Indigenous Australians; inequality; telehealth; vision impairment; vision loss EN Blindness COVID-19 equity eye health Indigenous Australians inequality telehealth vision impairment vision loss 215 217 3 03/08/23 20230301 NES 230301 COVID-19 and Aboriginal and Torres Strait Islander eye health Over recent years there have been notable improvements in Aboriginal and Torres Strait Islander eye health outcomes, such as an increase in overall screening and treatment coverage rates of common eye diseases and decreasing rates of blindness.[[1], [3]] However, vision loss remains at least three times more prevalent amongst Aboriginal and Torres Strait Islander peoples than among other Australians. Similarly, in rural South Australia, where travel was restricted for approximately four months in 2020, and again from December 2021 to March 2022, the regional health service initiated a tele-optometry program that utilised an ophthalmic nurse and an off-site optometrist to collaborate in providing refractive and eye health assessments approaching that which is available with traditional face-to-face care. Examples of successful models include a health service in the Northern Territory, where an ACCHS-employed Aboriginal eye health coordinator acted as a central point of contact for both the optometrist and the primary health care staff of the region, facilitating effective patient triage and support. [Extracted from the article]

The unforeseen circumstance of income loss from Medicare rebates and the additional cost per patient in the form of personal protective equipment and use of disposable contact equipment means that optometrists and practice owners will need to develop financially sustainable strategies to ensure that they can continue to safely provide effective primary eye care. Keywords: Coronavirus; eye care; personal protective equipment; primary care; SARS-CoV-2 EN Coronavirus eye care personal protective equipment primary care SARS-CoV-2 728 733 6 08/03/21 20211101 NES 211101 Introduction Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first identified in December 2019. A similar approach has been previously described for self-tonometry using devices like the Icare HOME.[13],[14] Like any health care plan involving patient compliance, the deployment of remote testing technologies still requires patients to use the devices in an accurate and timely fashion to maximise their effectiveness and validity. Could telehealth help eye care practitioners adapt contact lens services during the COVID-19 pandemic?. [Extracted from the article]

This study was conducted to determine economic inequality in Eye Care Services Utilization (ECSU) and its determinants in the underserved rural population of Iran In this population-based study, two underserved regions in the north and southwest of Iran were randomly selected and 3850 individuals living in these regions were invited to participate in the study. ESCU was defined as a history of at least one optometric or ophthalmologic visit during the lifetime. Concentration index (C) was used to evaluate economic inequality and the Oaxaca– Blinder decomposition was applied to decompose the gap between the rich and poor. Of 3851 individuals, 3314 participated in the study (response rate: 86%). The data of 3094 participants were analyzed. The concentration index was 0.139 (95% CI: 0.218 − 0.590), indicating a pro-rich inequality in the ECSU. The ECSU was 12.38% (10.46 to 14.31) in the poor and 21.15% (18.38 to 23.92) in the rich, and the gap between them was about 90% in favor of the rich (p < 00.001). A marked percentage of the gap was due to the explained portion (b: −11.49; p <.001). The unexplained portion coefficient was b: 2.72 (p: 0.020). In the explained portion, economic status (b: −12.37; p <.001) and age (b: 0.90; p: 0.021) caused inequality in favor of the rich and poor respectively while only economic status (b:-21.1; p <.001) had a significant effect on inequality in favor of the rich in the unexplained portion. There is a significant pro-rich inequality in ECSU in the rural areas of Iran. A major portion of this inequality is related to differences in age and economic status between the two groups. Economic status has direct and indirect effects on inequality in ECSU; therefore, health policymakers should focus on economic improvement to remove the gap. [ABSTRACT FROM AUTHOR]

Background: The New Zealand Ministry of Health provides funding for the delivery of health care across regions via 20 District Health Boards. Funding includes the subsidisation of therapeutic pharmaceutical agents/drugs. The distribution of optometrists and ophthalmologists across the regions was investigated to understand the accessibility of eye care in New Zealand. Changes made to the optometrists' scope of practice in 2005 and in 2014 increased the range of drugs that suitably qualified optometrists could prescribe. Therefore, the distribution of optometrists authorised to prescribe drugs and those not authorised to prescribe drugs was also investigated.Methods: Information from the New Zealand Optometrists and Dispensing Opticians Board register and information from the Medical Council's website were used to create a database of ophthalmic practitioners and their locations. The χ2 goodness-of-fit test was carried out to determine whether the distribution of the number of practitioners across the regions was in proportion to the population of the regions.Results: Ophthalmologists were distributed across the regions in proportion to the regional population size. However, optometrists were concentrated in Auckland and other regions with high populations. Optometrists authorised to prescribe drugs comprised over 74 per cent of optometrists and were the majority of optometrists in most regions. Many of the regions with populations less than 200,000 had high population-to-practitioner ratios, indicating that they may not have sufficient numbers of ophthalmic practitioners in order to provide for the ocular needs of the community.Conclusion: Better distribution of the optometric workforce could make eye care more accessible in many regions of New Zealand. [ABSTRACT FROM AUTHOR]

The article offers information on eye images, health care, and biomedical innovation, conducted in Singapore between 2010 and 2014. Topic include describes the mutual tuning between the polyclinics (where diabetes screening is done) and the ocular imaging lab directed by Wong via discussions about image quality and the temporal structuring of diagnostic work.

Purpose: Barriers to health care present complex challenges to improving eye health in the U.S., yet few studies have quantitatively measured the impact of these barriers. This study investigated the time elapsed since a person's most recent eye examination (TLEE) as a measure of barriers to eye care. Methods: Participants (N = 1699) from mobile clinic vision health screenings completed demographic and subjective visual function questionnaires, and then underwent comprehensive eye exams. Associations between demographics, subjective visual function, and visual acuity were analyzed with respect to TLEE. Results: Many Hispanic (34.9%) and uninsured (28.6%) participants had no previous eye exam. Although most Caucasians had a previous eye exam, 40.2% did not have an exam in the previous four years. The majority of participants with diabetes were non-compliant with recommendations of annual eye examinations. Conclusion: These results describe barriers that are specific to subpopulations, providing useful information for efforts to improve eye care access. [ABSTRACT FROM AUTHOR]

Archaeological and archival data from a World War II internment camp where a predominantly Japanese American population was incarcerated offers a glimpse into the United States government's compliance with the Geneva Prisoners of War Convention of 1929. The Geneva Convention outlines the basic necessities afforded to prisoners of war and non-citizens, such as access to leisure activities; alcohol; dental and ophthalmological care; and medical facilities. The study of vision and eye-related artefacts, such as safety goggles and eye medicine, provides an opportunity to examine how prisoners' health was managed by the United States government during World War II. [ABSTRACT FROM AUTHOR]

Introduction: Age related macular degeneration (AMD) affects over 14 million people worldwide and is the commonest cause of visual loss in the over 65’s age group in the industrialised world. The neovascular form of AMD (nAMD) is responsible for the majority of severe visual loss. The introduction of anti-vascular endothelial growth factor (anti-VEGF) agents in the mid 2000’s revolutionised the treatment of nAMD. Of the current three anti-VEGF agents widely used, Aflibercept (EYLEA®; Regeneron Pharmaceutical Inc., Tarrytown, NY, USA/Bayer Healthcare, Berlin, Germany) was the latest to be introduced. Areas covered: The different forms of AMD and previous treatments for nAMD are described. Current treatment regimens using anti-VEGFs are reviewed with particular emphasis on aflibercept, its specific properties and dosing strategies. Expert commentary: Clinical trials demonstrated that aflibercept achieved the same results using an 8 weekly dosing regimen, compared to a 4 weekly ranibizumab regimen. This reduction in injection frequency reduces hospital visits, thus benefiting patients and hospital eye services. Different treatment regimens including ‘as required’, and ‘treat and extend’ protocols have enabled further reductions in injection frequency, but with careful monitoring to avoid visual loss. Further developments are required to identify those who need fewer injections. The introduction of longer lasting, or topical agents, or strategies for primary prevention represent potential future developments. [ABSTRACT FROM AUTHOR]

The article offers insight to the laws governing health care under U.S. False Claims Act (FCA). Topics discussed include analysis of the misapplication of the FCA to health care quality cases; history of how health care came under the FCA; and United States v. NHC Healthcare Corp. case addressing the same.

Background: Lions Outback Vision provides a telehealth service ('the telehealth service') to rural and remote communities in Western Australia aiming to deliver timely ophthalmic care to this underserved population. A number of barriers to its use were identified by an initial prospective audit. A multifaceted intervention was designed to increase the use of the telehealth service by optometrists.Methods: Optometrists referred patients from rural and remote Western Australia to the telehealth service. Two five-month prospective audits of the telehealth service were compared. The first, in 2012, was prior to the implementation of the intervention. The second, in 2014, was during the period of the intervention, which included logistical support, remuneration to optometrists, a more user-friendly referral pathway and awareness raising. The outcome measures were the number of consultations conducted during the two audit periods and other quantitative changes to the telehealth service.Results: After implementation of the intervention, use of the telehealth service increased 3.5 fold. A greater percentage of referrals were for non-urgent conditions (145 [69 per cent] versus 16 [32 per cent], p < 0.001) and less consultations recommended follow up with an ophthalmologist in clinic (42 [20 per cent] versus 17 [28 per cent], p = 0.04). Imaging studies were frequently used to supplement information provided by the referrer to the specialist during both audit periods.Conclusions: Optometrists used the telehealth service more frequently after the implementation of an intervention that addressed the barriers to its use. This has a number of potential benefits to rural and remote ocular health service provision in Australia. [ABSTRACT FROM AUTHOR]

Purpose: The World Health Organization (WHO) recommends that Southeast Asian countries have ≥1 ophthalmologist per 100,000 persons, equally distributed in urban and rural areas. However, regional patterns of eye care have been poorly characterized. This study investigates the distribution of ophthalmologists in Thailand and provides regional estimates of access to ophthalmologists. Methods: We geocoded the work address of ophthalmologists listed in the 2008 directory of the Royal College of Ophthalmologists of Thailand. We determined the number of ophthalmologists per 100,000 persons at the national, provincial, and district levels using data from the 2000 Thai Population Census, and assessed demographic factors associated with meeting the WHO recommendation of ≥1 ophthalmologist per 100,000 persons. Results: In 2008, Thailand had 1.52 ophthalmologists per 100,000 persons; however, only 20 of 76 provinces (26%) and 134 of 926 districts (14%) met the WHO recommendation of ≥1 ophthalmologist per 100,000 persons. District factors associated with not meeting the WHO recommendation included a high proportion of children, a high proportion of elderly, and a high proportion of rural residents. Conclusion: Thailand meets the WHO's goal for access to ophthalmologic care, but the distribution of ophthalmologists is uneven, with less access to ophthalmologic care in rural areas. [ABSTRACT FROM AUTHOR]

Purpose: To determine the use of medical services for eye problems in Fiji, and barriers to seeking that care. Methods: An interview-based questionnaire was administered as part of a population-based cross-sectional survey of adults selected by multistage random sampling from those aged ≥40 years living on Fiji's main island. Results: Participation rate was 73.0% (n == 1381). A current vision or eye problem was reported by 931 participants, and a further 235 recalled a previous difficulty. Urban dwellers ( P == 0.002) and those aged ≥50 years ( P == 0.017) were more likely to report a problem. Gender was not predictive ( P == 0.215). 'Blurred/poor vision' was the most common complaint (78.5%). Over half (53.3%) had not sought care for the problem most important to them. For current problems, being younger ( P < 0.001) and from a household without paid income ( P == 0.007) were predictive of being less likely to seek treatment. Gender was not ( P == 0.416). The most frequently cited principal reason for not seeking care was 'able to manage/accept the problem' (66.5%; of whom 84.7% claimed vision problems). Direct and indirect costs were mentioned as deterrents. 'Thought nothing could be done' ( P == 0.032) and 'lack of awareness of service availability' ( P == 0.026) were more common among rural dwellers. Of participants who sought care, 75.6% used government services. Most participants requiring spectacles or medication incurred costs for these. Satisfaction with overall care was independent of provider ( P == 0.062) and user gender ( P == 0.851). Conclusion: With expanding service delivery, increased eye health promotion, and attention to the financing of treatments, improved service use ought to be possible in Fiji. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical features and surgical preferences of patients with neurofibromatosis. Methods: Histologically confirmed neurofibromatosis cases that underwent surgery during a 15-year period were retrospectively evaluated. The patients' demographics, severity of periorbital involvement, aim of surgery, surgery types, postoperative outcome, and complications were recorded. Results Nineteen patients with a mean age of 24.7 ± 21.2 years were included in the study. Nine were younger and 10 were older than 16 years. Seventeen patients had unilateral and two had bilateral involvement. Patients were followed for a mean of 5.8 ± 5.7 years. A total of 35 surgeries were performed. In 22 times the surgery was performed to improve vision, and in others to get a cosmetically acceptable appearance. Although there was an improvement in visual acuity, the difference was not significant (P = 0.085). Debulking of the tumor was performed in 100%, ptosis surgery in 90%, and lateral canthal fixation in 50% of surgeries. All patients showed improvement: at the last examination, six eyes had no ptosis, in 13 eyes ptosis not covering the pupil in primary gaze was observed on the involved side, and in only one eye the pupil was half covered. Conclusion In neurofibromatosis the treatment should be customized to each patient. As confirmed in our study, an open visual axis is the main goal in surgery, followed by cosmetic appearance. The authors believe that, with possibly multiple surgeries an acceptable result can be achieved. [ABSTRACT FROM AUTHOR]

Purpose: To determine the extent and reasons for delay in accessing specialist eye care following a significant eye injury. Methods: Mixed methods study involving 93 consecutive admissions to Kilimanjaro Christian Medical Center, Tanzania (KCMC). Semi-structured interviews were conducted and supplemented by a review of medical notes. A statistical analysis of delay and predictor variables was conducted. Framework analysis of interviews was conducted. Results: Ninety of 93 patients took part. Significant visual loss was determined in 95.5% of affected eyes on arrival. The mean delay for treatment was 6.8 days. Of participants, 61.1% visited some health facility within 24 hours, and 82.2% within 48 hours. Injury on a weekend, using topical drops and visiting other health facilities before KCMC were independently associated with delay greater than 24 hours and greater than 48 hours, female gender with was associated with delay greater than 24 hours. Patient journeys involved key milestones and processes. Journeys were frequently “circular,” involving delays caused by repeated visits to health units unable to treat the injury, often on a health worker’s advice. Systems problems included unclear referral systems and opening times, frequent staff absence and unqualified staff deputizing. Individual health workers had an important influence on delay but their performance appeared variable. They influenced patient journeys positively when they made an accurate diagnosis, referred directly to KCMC, discussed practicalities and communicated the seriousness of the injury, the need for urgent treatment and the adverse consequences of delay. Conclusions: There is significant delay in accessing appropriate specialist care following eye injury in Tanzania, much of which occurs after first visiting a health facility. We present a new model of delay that may help guide interventions to reduce this delay. [ABSTRACT FROM AUTHOR]

With multifocal intraocular lenses, the majority of the patients do not wear glasses after cataract surgery which is a potential source of savings. Purpose: To collect data in four European countries on the associated costs for society of wearing spectacles after cataract surgery and the patient willingness to pay to be free of spectacles. Methods: Cross-sectional survey of centers that recruited patients who wore refractive spectacles after cataract surgery. Costs were expressed in 2006 Euros Results: 408 patients were recruited by 22 centers. Patients with a mean age of 68.5 years underwent cataract surgery about 3 years prior to recruitment. In all countries, prescribed lenses were mainly mono-focal and the mean cost of spectacles was EUR366.3. Half the patient population with private health insurance was reimbursed for spectacles at a level of 50%, except Spanish patients who were reimbursed at only 5.3%. However, a large part of the cost was directly paid by the patients. Out of a total mean cost of EUR354.9, patients paid EUR285.2 and health insurances only EUR69.7. More than half the patients were willing to pay at least 0.5EUR/day to be free of spectacles. Conclusion: Large differences were found among the 4 countries. Almost half of all subjects had private health insurance. The total cost of refraction includes a variety of resources not limited to spectacles. A large part of the cost was borne by patients and there is a high patient willingness to pay to be free of spectacles in this population. [ABSTRACT FROM AUTHOR]

Eye and health care are and always will be both art and science. The science of discovery, its translation to clinical care and the education that necessarily follows for practitioners is witnessing remarkable change and increasing impact on patient care. An independent and vibrant profession commits to discovery as a basis of better patient care; optometry is no exception. Some recent discoveries in our field are breathtaking and the increasing awareness in health care, including in optometry, of the advantages of accepting the challenge of translating these discoveries to patient care is becoming more evident. Health-care practice is increasingly evidence-based on careful science. The implications of evidence-based health care are surprisingly broad, with impact on clinical care guidelines, reimbursement, future scope of practice responsibilities and education both within our schools of optometry and for our practitioner. [ABSTRACT FROM AUTHOR]

Objectives: To identify the perceived barriers to the provision of clinical low-vision service among ophthalmologists in Nigeria, with a view to proffering measures for their removal. Methods: A cross-sectional survey of ophthalmologists attending the Annual Ophthalmological Society of Nigeria Congress in September 2005 was conducted. Using self-administered questionnaires, information relevant to low-vision practice and the perceived barriers to the provision of low-vision services was garnered. Results: Eighty-three (70.9%) ophthalmologists out of 117 eligible participants at the congress responded to all of the questions and returned the study questionnaires. Non-availability of low-vision devices within the country (88%), lack of training in low-vision care (73.5%), lack of public awareness of low-vision care and its practitioners (60.2%), and the ophthalmologists' preoccupation with general ophthalmic practice (56.6%) were cited as the major barriers. With regard to the fellows and the residents in training, there was a statistically significant difference in their perception of two of the investigated barriers, namely, that low-vision care is not lucrative (T value: 4.46; 95% CI: 0.16± 0.07) and low-vision care is time-consuming (T value: 2.05; 95% CI: 0.145± 0.14). Conclusion: Training in low-vision care should be provided within the country for interested relevant personnel at all levels. Moreover, low-vision devices should be made accessible and available to the practitioners. There is a need in Nigeria for widespread health education/awareness campaigns in low-vision care, targeted primarily at ophthalmologists, allied eye-care providers, and the general public. There is a need to include low-vision practice in the curriculum of the ophthalmology residency program in Nigeria. Further qualitative research may need to be conducted to explain the differences in responses between subsets of the study population. [ABSTRACT FROM AUTHOR]

Eye health-care in Australia encompasses patients with chronic disorders being referred to ophthalmologists for detailed assessment and subsequent management. An increasing case load and relative decrease in ophthalmologists predicted over the next few years portend of an upcoming bottleneck in care delivery. To improve the efficiency and effectiveness of patient care within a rapidly changing health system, we propose that minor adjustments to existing services could improve the proficiency of resources. Such changes will require service providers to rethink their positions and roles and actively collaborate with each other for improved patient outcomes. [ABSTRACT FROM AUTHOR]

The author discusses the need of developing primary eye care facilities across the world and also analyzes the effort being taken by several international agencies like World Health Organization (WHO) and global eye-health initiatives, like VISION 2020. He also offers suggestions for expanding medical care facilities related to ophthalmic diseases and eradicating cause of avoidable blindness worldwide.

Purpose: Intracanalicular plugs are commonly used in the management of dry eyes. The authors report 3 cases of complications associated with intracanalicular plugs. Methods: Clinical findings and the management of these patients are presented. Results: The first patient (case 1) is a 47-year-old female with severe dry eyes. Six months after insertion of intracanalicular Form fit hydrogel plugs (OASIS® Medical) she developed canaliculitis with Klebsiella oxytoca. The second patient (case 2), a 33-year-old female, who developed left canalicular abscess 5 months following the insertion of bilateral, intracanalicular Form fit hydrogel plugs (OASIS® Medical). The third patient (case 3) a 33-year-old female had granulation tissue formation within the left lower canaliculus, 5 years after insertion of intracanalicular plug. The symptoms in the three patients resolved after they underwent canaliculotomy with removal of the plugs. Conclusion: Complications of intracanalicular plugs can sometimes outweigh their benefits. These plugs can lodge in the lacrimal outflow system and cause pyogenic granuloma formation and canaliculitis. To our knowledge, until now there have been no reports of complications associated with Form Fit hydrogel plugs (OASIS® Medical) and its infective complication with Klebsiella oxytoca. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including eye and vision care in children, the association between children's eye care and ethnicity, and the impact of amblyopia on monocular vision.

In this article, the author discusses the report "Making Eye Health a Population Health Imperative: Vision for Tomorrow" from the National Academies of Sciences, Engineering and Medicine (NASEM) for improving eye and vision health. Topics include separation of the eye and vision care system from healthcare system diminished attention paced on it, poor access to eye care providers and for patients in rural areas such as persons with diabetes and building of effective surveillance system.

The author reflects on the systematic change to improve access for diabetic eye care. He states that more Australians estimated living and diagnosed with diabetes, a progressive condition result in damage the blood vessels of the retina due to lack of control of blood sugar levels. And an overview of the guidelines for the examination and management of patients with diabetes was mentioned.

The article presents abstracts on medical topics including one related to the problem of getting older, second related to the diabetic retinopathy and dementia and another related to the eye care.

The article presents a case study related to macular haemorrhage. The case study pertains to a 26-year-old female presented with a small area of visual distortion in her right eye for two days. Patient told that she had ridden on roller coasters. Amsler grid showed a small area of metamorphopsia inferior nasal to fixation in the right eye. The study reveals that repetitive, rapid, multidimensional accelerations may cause mechanical disruption of a macular vessel.

Provides information on the document Standard List of Medicines, Equipment, Instruments, and Optical Supplies appropriate for the delivery of eye care services in developing countries.