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To assess differences in eye care utilization by vision difficulty (VD), diabetes status, and sociodemographic characteristics for American adults. The analysis pooled cross-sectional data from the National Health Interview Survey (2010–2018) from US adults ≥ 18 years. The outcome measure was eye care utilization in the past year. The primary independent variable included four groups: no VD or diabetes, only diabetes, only VD, and diabetes and VD. VD was defined as self-reported difficulty seeing even with glasses or contacts. Diabetic status was defined as ever receiving this diagnosis by a health professional. Multivariable logistic regression analyses examined associations between eye care utilization, VD, diabetic status, and sociodemographic characteristics. Of the 284,599 adults included in this study, the majority were female (55%), White (73%), and non-Hispanic (84%). In regression analysis, as compared to adults without diabetes or VD, adults with both diabetes and VD had the greatest utilization (OR = 2.49, 99% CI = 2.18–2.85). Females had higher utilization than men (OR = 1.45, 99% CI = 1.41–1.50). Higher levels of education was associated with greater utilization (OR = 1.82, 99% CI = 1.72–1.92). White and American Indian adults without diabetes had higher utilization compared to other races (OR = 1.17, 99% CI = 1.12–1.24, 0.98–1.39). While adults with VD and diabetes are better connected to eye care, significant eye care disparities persist for marginalized groups in the U.S. Identifying and understanding these disparities and eliminating barriers to care is critical to better support all patient populations. [ABSTRACT FROM AUTHOR]

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

Determine current vision care pathways and practices for stroke survivors in Australia and internationally, focusing on identifying reoccurring gaps in these pathways and unmet care needs. A scoping narrative review was conducted to identify literature related to post-stroke vision care practices and perspectives of patients and health professionals. A total of 16193 articles were retrieved and 28 deemed eligible for inclusion. Six were Australian, 14 from the UK, four from the USA, and four from within Europe. Post-stroke vision care is largely unstandardized, with substantial inconsistency in the use of vision care protocols, who executes them and at what point in post-stroke care they are utilised. Health professionals and stroke survivors expressed that unmet care needs were primarily a result of lack of education and awareness regarding post-stroke eye problems. Other gaps in care pathways related to the timing of vision assessment, provision of ongoing support, and the integration of eye-care specialists into the stroke team. Further research is needed into current Australian post-stroke vision care to accurately assess whether the needs of stroke survivors are being met. Available evidence indicates that in Australia, there is a requirement for well-defined protocols for vision screening, education, management, and referral of stroke survivors. Post-stroke vision care in Australia is unstandardised, which may cause inequities in vision care provision to Australian stroke survivors in different regions and/or care facilities. Education and training pertaining to stroke-related vision conditions for stroke healthcare professionals and the inclusion of eye-care professionals in stroke care teams is likely to improve gaps in care practice/pathways identified in the current evidence base. Management of stroke-related visual conditions should be inclusive of detailed information provision that is specific to the patients condition(s) and circumstances, as well as ongoing, long-term management strategies/support services to better aid stroke survivor"s reintegration into the community. [ABSTRACT FROM AUTHOR]

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]

Axial length is a primary outcome in the management of progressive myopia. However, young children may have difficulty fixating during these measurements compared to older children, which can result in higher measurement variability. This may affect perceived axial length progression, leading to inappropriate management. This study assessed the impact of patient age on measurement variability for axial length measurements taken with the IOLMaster 700 and IOLMaster 500 in myopic children. A retrospective review of records was undertaken at a university optometry clinic. Five axial length measurements captured at the same visit were collected with the IOLMaster 700 and IOLMaster 500 for myopic patients ≤16 years. The within-subject standard deviation and R2 were calculated for each instrument to examine the effects of age on instrument variability. Data was collected for 51 patients (30 female and 21 male), and the mean age was 10.98 ± 2.77 years. Mean axial length measured with the IOLMaster 700 was longer compared to the IOLMaster 500 (difference −0.02 ± 0.02 mm; p < 0.001). There was no effect of age on within-person variability for the measurement of axial lengths with either instrument, with R2 values of 0.021 (p = 0.305) and 0.13 (p = 0.420) for the IOLMaster 700 and IOLMaster 500, respectively. The within-subject variability of axial measurements with the IOLMaster 700 was significantly lower than that with the IOLMaster 500 (p < 0.001). Measurement variability of axial length measurements with the IOLMaster 700 and IOLMaster 500 was not dependent on age. However, axial length measurements captured with the IOLMaster 700 were significantly longer and less variable than those with the IOLMaster 500. Eye health care practitioners should be aware of the differences between the two instruments and refrain from using them interchangeably, especially for myopia control where small changes in axial length can affect patient management. [ABSTRACT FROM AUTHOR]

An analysis of the professional perspective of vision therapy (VT) by eye care professionals allows understanding the current controversies about this therapeutic option of which aspects can be improved for its correct application in clinical practice. The aim of the current study was to analyse the perception of VT and the clinical protocols in this context followed among optometrists and ophthalmologists in Spain. A cross-sectional survey among Spanish optometrists and ophthalmologists. Google Forms tool was used to collect data via an online questionnaire divided into 4 sections (40 questions): consent to participate, demographic characteristics, opinion of the professional perspective of VT, and protocols. Only one submission from each email address was permitted by the survey tool. A total of 889 Spanish professionals answered (age, 25–62 years): 848 optometrists (95.4%) and 41 ophthalmologists (4.6%). VT was considered as a scientifically-based procedure by 95.1% of participants, but its recognition and prestige was considered as low. The main cause reported for this was bad reputation or perception of placebo therapy (27.3%). The main indication of VT according to the surveyed professionals was convergence and/or accommodation problems (72.4%). Significant differences were found in the perception of VT among optometrists and ophthalmologists (p ≤ 0.027). A total of 45.3% of professionals reported performing VT in their current clinical practice. A combination of training sessions in office and home was regularly prescribed by 94.5% of them, but with significant variability in the duration of such sessions. VT is perceived by Spanish optometrists and ophthalmologists as a therapeutic option with scientific basis, but with limited recognition and prestige, although with more negative perception among ophthalmologists. A great variability was found in the clinical protocols followed between specialists. Future efforts should be focused on creating internationally recognised evidence-based protocols for this therapeutic option. [ABSTRACT FROM AUTHOR]

There is a lack of clinical guidelines in India for the prescription of blue-blocking lenses. Therefore, the practice trends will depend on practitioners' knowledge, attitude, and perception. Exposure to blue light with increased use of light-emitting diode (LED) lights and digital devices along with the commercial availability of blue blocking lenses has warranted the need to understand the factors that influence the prescription of blue blocking lenses among eye care practitioners. Hence, we aim to assess knowledge, perception, and practice pattern of blue blocking lenses among Indian optometrists. This cross-sectional online survey was conducted among Indian Optometrists. The survey was distributed through various social groups of optometrists and state associations. The questionnaire had four main domains with 29 items in total. The four major domains were knowledge, practice, perception and demographic details on education. Descriptive analysis and logistic regression were performed to study the impact of these domains on the prescription of blue block lenses. Out of 341 responses, 247 were included for analysis as per study criteria. About 50% (n = 123) of the participants had appropriate knowledge about blue light. Blue-blocking lenses were prescribed always or most of the time by 52% (n = 130) of the participants. The odds of prescribing blue blocking lenses were higher among practitioners who considered blue light as an important factor in causing computer vision syndrome (OR 3.77, 95% CI: 1.33–10.69, P = 0.01) or if they considered there is adequate published evidence (OR 3.95, 95% CI: 1.58–9.87, P = 0.003). The source of evidence for prescribing blue-blocking lenses for our participants was mainly from advertisements rather than from scientific studies. Factors such as awareness, knowledge, education, and nature of practice did not play a significant role in prescribing blue-blocking lenses. This raises the need for evidence-based practice and the development of practice guidelines for prescribing blue-blocking lenses. [ABSTRACT FROM AUTHOR]

Goldmann applanation tonometry is widely used for the diagnosis and management of glaucoma and its use is considered standard of care. However, the precision of this method may be reduced by a clinician tendency to round to even numbers. Studies have previously demonstrated an even-number measurement bias with Goldmann applanation tonometry during examination of a general patient population. Since it has not been determined whether this bias persists among glaucoma suspects and patients with glaucoma, further investigation was conducted. A retrospective analysis was conducted on a random sample from a large dataset of >69,000 patients seen during a six-year period at an urban, academic primary eye care service. Patients without suspicion of glaucoma, patients with a suspicion of glaucoma, and patients with glaucoma were selected who had Goldmann tonometry performed. Chart reviews were performed to confirm status, and even/odd-numbered Goldmann tonometry measurement frequencies were compared. The analysis included 961 controls, 506 glaucoma suspects, 159 ocular hypertensives not taking medication, and 314 patients taking medications who carried a diagnosis of glaucoma or ocular hypertension. Among controls the Goldmann tonometry even/odd digit proportions were 62.8%/37.2% (N = 961, p < 0.0001), and the even-number bias persisted among the other groups with specific even/odd distributions being 61.9%/38.1% (N = 506, p < 0.0001) for glaucoma suspects not taking medications, 66.0%/34.0% (N = 159, p < 0.0001) for ocular hypertensives not taking medications, and 64.3%/35.7% (N = 314, p < 0.0001) for glaucoma/ocular hypertension patients taking medications. An even-number measurement bias with Goldmann tonometry may be prevalent even when the examiner is aware of there being greater importance for intraocular pressure measurement accuracy. [ABSTRACT FROM AUTHOR]

Measuring the impact of spatial attention on signal detection in damaged parts of the visual field can be a useful tool for eye care practitioners. Studies on letter perception have shown that glaucoma exacerbates difficulties to detect a target within flankers (crowding) in parafoveal vision. A target can be missed because it is not seen or because attention was not focused at that location. This prospective study evaluates the contribution of spatial pre-cueing on target detection. Fifteen patients and 15 age-matched controls were presented with letters displayed for 200 ms. Participants were asked to identify the orientation of the target letter T in two conditions: an isolated letter (uncrowded condition) and a letter with two flankers (crowded condition). The spacing between target and flankers was manipulated. The stimuli were randomly displayed at the fovea and at the parafovea at 5° left or right of fixation. A spatial cue preceded the stimuli in 50% of the trials. When present, the cue always signalled the correct location of the target. Pre-cueing the spatial location of the target significantly improved performance for both foveal and parafoveal presentations in patients but not in controls who were at ceiling level. Unlike controls, patients exhibited an effect of crowding at the fovea with a higher accuracy for the isolated target than for the target flanked by two letters with no spacing between the elements. Higher susceptibility to central crowding supports data showing abnormal foveal vision in glaucoma. Exogenous orienting of attention facilitates perception in parts of the visual field with reduced sensitivity. [ABSTRACT FROM AUTHOR]

In high-income countries where eye care is advanced, cornea harvesting is hidden from public view. Here entire eyeball enucleations performed on corpses are done in hospital morgues without mourners' presence. For the last two decades, the traditional public crematorium area next to the Pashupatinath temple at the holy river Bagmati east of Kathmandu, has become a major Nepal Eye Bank site for motivated cornea donations. To be cremated in the premises of the Pashupatinath temple is considered highly auspicious. After families have given their consent, the cremation rituals are briefly interrupted by the Nepal Eye Bank staff, and cornea button excisions are performed in public space. Thus, mourners regularly view and assist during the removal of cornea button tissues from the deceased before the bodies are burned on the open funeral pyres or in the electric crematorium. How is it that Nepali mourners at Pashupati crematorium accept and comply with cornea donation practice? I argue that cornea donation at Pashupati is a collective achievement accomplished by complex socio-material arrangements that bring together various professionals, procedural manuals, legal framework, equipment, medical intervention, the deceased body, and mourners during the cremation practice. [ABSTRACT FROM AUTHOR]

The objective of our study is to understand the factors associated with non-adherence to the physician's follow-up advice by persons with glaucoma. We use a four-year panel dataset containing demographic, clinical, and intervention details and doctor's advised follow-up date for a random sample of 2,622 glaucoma patients from an Indian tertiary eye care hospital. We model this unique "advised follow-up date" in multivariate logistic regressions to identify factors associated with patients' coming early or late as against on-time. An OLS regression also examines an association between delayed follow-up and declining visual acuity. Demographic variables such as age, gender, distance to hospital, IOP, and visual acuity were not associated with delayed adherence to follow-up. Patients advised to review within 2 months (p <.001), paying patients (p <.001), and those habituated to routine follow-up (diabetes patients) (p <.01) are less likely to delay care-seeking. Patients are more likely to come on-time in visits immediately after clinical interventions relative to later ones (p <.001). Our second analysis reveals the presence of cataract and the very first post-surgery visit as factors influencing patients to come early. Our third analysis reveals that a higher proportion of delayed visits had resulted in worsening of vision in the glaucoma-affected eye. Our results suggest that active counselling by doctors, especially for routine follow-up visits, can help in better follow-up adherence and prevention of glaucoma-related visual impairment. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the prevalence and main causes of blindness and visual impairment in population aged 50 years and older in Armenia using Rapid Assessment of Avoidable Blindness (RAAB) methodology. The study team randomly selected 50 clusters (each consisting of 50 people) from all 11 regions of Armenia. Data on participants' demographics, presenting visual acuity, pinhole visual acuity, principal cause of presenting visual acuity, spectacle coverage, uncorrected refractive error (URE), and presbyopia were collected using the RAAB survey form. Four teams of trained eye care professionals completed data collection in 2019. Overall, 2,258 people of 50 years and older participated in the study. The age- and gender- adjusted prevalence of bilateral blindness, severe and moderate visual impairment were 1.5% (95% CI: 1.0–2.1), 1.6% (95% CI: 1.0–2.2) and 6.6% (95% CI: 5.5–7.7), respectively. The main causes of blindness were cataract (43.9%) and glaucoma (17.1%). About 54.6% and 35.3% of participants had URE and uncorrected presbyopia, respectively. The prevalence of bilateral blindness and functional low vision increased with age and was the highest in participants 80 years and older. The rate of bilateral blindness was comparable with findings from countries that share similar background and confirmed that untreated cataract was the main cause of blindness. Given that cataract blindness is avoidable, strategies should be developed aiming to further increase the volume and quality of cataract care in Armenia. [ABSTRACT FROM AUTHOR]

Low vision is an uncorrectable form of visual impairment that affect millions of people worldwide. Low vision care and rehabilitation are essential to improving the independence of affected individuals. Even though sub-Saharan Africa has one of the highest burdens of low vision globally, there are inadequate care and rehabilitation services in most countries and in some cases they are non-existent This scoping review aimed to identify the barriers and enablers to low vision care and rehabilitation in sub-Saharan Africa and assess these within the global context. The review was conducted using the five-step Arksey and O'Malley framework. Search terms were formulated based on the research questions and a search strategy was designed to search for eligible research articles from electronic databases; Pubmed, Ovid, Medline, and Embase. The data was screened by two members of the research team in accordance with set inclusion and exclusion criteria. Twenty-five out of 260 articles satisfied the inclusion criteria for the study. Inadequate low vision care infrastructure and supplies, non-standardised training of low vision care providers, health system failure and poor awareness of low vision care were the main barriers noted by eye care practitioners. Patients living with low vision cited the cost and availability of low vision aids, societal stigma, and poor awareness of services as the main barriers. No direct enablers were identified in sub-Saharan Africa; however, practitioners suggested improved training in low vision as a potential enabler. The barriers to low vision care and rehabilitation services identified were not unique to sub-Saharan Africa when viewed within a global context. Adopting and adapting solutions from other countries may therefore assist in improving low vision care and rehabilitation in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Accurate thickness measurement of corneal layers using anterior segment OCT can be used to improve visual outcomes. Understanding its applications is essential for optometric practices to enhance eye care procedures. To evaluate the thicknesses of different corneal layers for identifying keratoconus (KCN) and subclinical keratoconus (SKCN) using spectral-domain optical coherence tomography (SD-OCT). This prospective study analyzed 60 eyes with KCN, 48 eyes with SKCN, and 53 normal eyes. The central corneal thickness (CCT) and thicknesses of the epithelium, Bowman, stroma, and Descemet-endothelium layers were measured using SD-OCT. One way analysis of variance and the area under the curve (AUC) were used to evaluate the parameters. The Delong method was used to compare AUCs. In KCN, CCT and thicknesses of epithelium, Bowman, stroma, and Descemet-endothelium layers were 495.5 ± 41.7, 52.6 ± 6.4,11.5 ± 1.4, 415.5 ± 38.9, and 12.3 ± 1.7 µm, respectively. These thickness values were respectively 524.5 ± 33.3, 56.8 ± 6.8, 11.5 ± 1.6, 439.8 ± 30.6, and 12.4 ± 1.7 µm in SKCN and 563.8 ± 37.9, 57.7 ± 6.9, 12.2 ± 1.6, 469.5 ± 33.7, and 12.8 ± 2.1µm in normal group. Total cornea and stroma in KCN and SKCN, and epithelium in KCN were significantly thinner compared to the normal group (P < 0.001). The highest AUC values were observed for CCT in KCN (AUC 0.90) and SKCN (AUC 0.782). The diagnostic accuracy was significantly higher for stromal thickness in KCN (sensitivity 81.7%, specificity 73.6%, AUC 0.871) and SKCN (sensitivity 80.0%, specificity 56.6%, AUC 0.751) than other individual corneal layers (Delong, P < 0.001). CCT can accurately distinguish keratoconus from normal eyes. However, central corneal stromal thinning was the most sensitive diagnostic index for early detection of SKCN. Developing standardized stromal maps may be helpful for detecting SKCN. [ABSTRACT FROM AUTHOR]

The similarity of parties' policy preferences has long been considered an important determinant of whether they form a government coalition. That similarity has typically been assessed based on parties' respective locations in a policy space. The degree to which parties care about different issues may, however, also vary. Parties that care about different issues may actually be the most compatible partners, as their tangential preferences would allow them to engage in policy logrolling and enable them to preserve their distinctiveness in the eyes of voters. This analysis tests arguments regarding the role of tangentiality and its interaction with policy proximity on the party composition of governments formed in Western Europe from 1945 to 2019. The findings show that parties that emphasise the same issues are more natural coalition partners provided the ideological differences between the parties are sufficiently similar. [ABSTRACT FROM AUTHOR]

Eye and foot problems are two of the most common consequences of diabetes. The goal of this study was to investigate the impact of an educational programme based on the Theory of Planned Behaviour (TPB) on foot and eye care among patients with type 2 diabetes mellitus in Fasa City, Fars Province, Iran. A total of 100 individuals with non-insulin-dependent diabetes mellitus (Type II) who met the study's inclusion criteria were included. The participants were randomly assigned to one of two groups (intervention = 50, control = 50). The questionnaires were completed by all groups and included demographic information, TPB constructs, foot and eye care, and patients' HbA1c levels. Questionnaires were completed prior to, immediately following, and three months after the intervention by members of the experimental and control groups. During the intervention period, the experimental group attended 10 instructive sessions. SPSS 22 software was used to analyse the data. Paired t-tests, independent t-tests, chi-square, and RMA (Repeated Measurement ANOVA) were all used (p < 0.05). Knowledge and all TPB components were significantly increased in the experimental group compared with the control group after intervention. In addition, foot and eye care practice and HbA1c level improved significantly among the experimental group compared with the control group (p < 0.001). Applying the TPB is quite helpful in designing an educational programme for diabetic people to control their blood sugar and improve behavioural foot and eye care. Aside from such programmes, follow-up education on regulating and monitoring is strongly advised. [ABSTRACT FROM AUTHOR]

To investigate health disparities in racial and ethnic minorities with dry eye. Medical records were reviewed for demographics, socioeconomic factors, treatments, and objective dry eye parameters. Race/ethnicity was self-reported as delineated by the U.S. Census. The reference group comprised of randomly selected White patients, with number equal to the largest minority group. The study included 465 patients (157 Black, 157 White, 85 Asian, and 66 Hispanic). Compared to White (3.2%) patients, larger proportion of minorities used Medicaid or lacked health insurance (Black 8.3%, P =.054; Asian 10.6%, P =.019; Hispanic 18.2%, P <.001). Black and Hispanic patients had lower estimated median household income than Whites (White $98,472, Black $75,554, P <.001; Asian $105,503, P =.088; Hispanic $86,839, P =.030). Prior to presentation, fewer minority patients received prescription treatments or procedures (White 61.8%; Black 30.6%, P <.001; Asian 43.5%, P =.006; Hispanic 43.9%, P =.014). Although at baseline visit minorities had worse mean conjunctival (White, 1.7; Black 2.2, P =.136, Asian 2.4, P =.022; Hispanic 2.6, P =.005) and corneal staining scores (White, 1.6; Black 2.5, P <.001; Asian 2.3, P =.003; Hispanic 2.4, P =.001), no differences were noted at final visit. Minorities presented with worse objective dry eye parameters, and less prior dry eye care. Income and health care access may not fully explain the observed undertreatment at presentation. Differential management by eye care providers and patient attitudes warrant further investigation. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo the best of our knowledge, implementation of artificial intelligence (AI)-based vision screening in community health fair settings has not been previously studied. This prospective cohort study explored the incorporation of AI in a community health fair setting to improve access to eyecare.Vision screening was implemented during a community health fair event using an AI-based non-mydriatic fundus camera. In addition, a questionnaire was provided to survey the various barriers to eyecare and assess eye health literacy.A total of 53 individuals were screened at this event. Notably, about 88% of participants had follow-up appointments scheduled accordingly with an approximate 62% attendance rate. The most reported barrier to eyecare was lack of health insurance followed by transportation.The addition of AI-based vision screening in community health fairs may ultimately help improve access to eye care. [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]

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. 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). 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). Simple eye-health education interventions, delivered during vision screenings and via community-based education, can improve eye-health knowledge. [ABSTRACT FROM AUTHOR]

Explore door-to-door eye screening in India as a model to reach school age children in need of eye care, especially during school closures due to the Covid-19 pandemic. Children between 5 and 18 years were screened in an urban-slum of Delhi from September 2020 to March 2021. Screening included capturing ocular complaints, visual acuity and conducting a torchlight examination. Children with any eye-related complaints, gross abnormality or a LogMAR acuity of more than 0.2 in either eye were referred to the nearby vision centre. Data were disaggregated by gender and age group. Reporting after referral and proportion of true positives referrals were used to assess the model. 32,857 children were screened. 55% were boys. Only 917 children (2.8%) had previous eye examinations. 1814 (5.5%) children were referred. Overall compliance rate amongst those referred was 59% (1070 of 1814) and compliance was significantly higher (72%) amongst those referred with poor vision as compared to those with only ocular morbidities (38%). Overall compliance was significantly higher amongst older age group (64% vs 50%) and amongst girls than boys (61% vs 56%). 3.9% children were detected with refractive error (RE) and 2.5% with uncorrected RE which was significantly higher in girls and in older age group. Of 1070 children reporting after referral, 85% had confirmed diagnosis for RE or other ocular pathology. Door-to-door screening had good referral compliance and positive predictive value. We recommend this model as a supplement to school screening especially in regions with low enrolment and high absenteeism in schools. [ABSTRACT FROM AUTHOR]

In response to the recommendations of the World Health Organization (WHO) World report on vision, the WHO is developing a Package of Eye Care Interventions (PECI) to support the integration of eye care into health systems within countries. This study was done to systematically review clinical practice guidelines (CPGs) related to age-related macular degeneration (AMD) to provide evidence-based recommendations. All AMD-related CPGs published between 2010 and 2020 were reviewed and evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Of 3778 CPGs identified, 48 underwent full-text screening and eight underwent quality appraisal. Five National Institute for Health and Care Excellence (NICE, UK) guidelines for AMD were finally selected for data extraction. Intravitreal anti-vascular endothelial growth factor (VEGF) treatment was strongly recommended for advanced, active neovascular AMD based on high-quality evidence. Photodynamic therapy and laser photocoagulation were not recommended as an adjunct to anti-VEGF therapy as first-line treatment for AMD. Recommendations on other interventions, including epiretinal brachytherapy, miniature lens system implantation, and limited macular translocation, were weak and evidence mostly came from low-quality case series studies. Hence these interventions were recommended to be used only with special arrangements or research. Existing evidence on treating geographic atrophy was limited, an implantable miniature telescope might be an effective intervention to improve vision but was still under investigation. Current CPGs recommend anti-VEGF therapy for patients with late active neovascular AMD, while other interventions should be used with caution and further researches are warranted. [ABSTRACT FROM AUTHOR]

Identifying potential barriers to contact lens wear could increase awareness about contact lenses and their benefits and boost the confidence of optometrists offering contact lenses to their patients. Contact lenses provide better visual performance according to many studies. Nevertheless, resistance to wearing them remains an issue. This study will identify barriers to contact lens wear among university students in Jordan. This study enrolled university students who wore spectacles for their refractive error correction and have had no history of contact lens wear. A questionnaire of potential barriers was constructed whereby participants were required to respond to a set of questions that asked how each suggested item was considered a barrier for contact lens wear; responses were recorded within a 5-points scale (1: strongly disagree to 5: strongly agree). A total of 260 participants (175 females and 85 males) were enrolled in the study. All participants showed normal findings for contact lens wear candidacy. The mean score of total barriers to contact lens wear was high, at 33.8 (±5.4 SD) (out of 55 the maximum possible score). The major identified barriers were: decision of eye care practitioners that contact lenses are unsuitable for them (64.6% of the study sample); decision of the participants that contact lens were unsuitable for their work environment (63.5%); and reported symptoms of ocular dryness (61.6%) that made participants reluctant to try contact lenses This work identified several patient-related barriers to contact lens wear. Probing these barriers may encourage eye care providers and contact lens manufacturers to promote contact lenses as a viable option for the correction of refractive error. This in turn will increase awareness among patients about contact lenses and encourage them to try contact lenses as alternative to spectacles. [ABSTRACT FROM AUTHOR]

To explore optometric practices and attitudes in the management of keratoconus patients in LatinAmerica and how they are influenced by eye-care technology will help to minimise disease progression and their impact on patients' quality of life in Latin America. Keratoconus is a progressive, bilateral and asymmetric corneal disorder that requires a multidisciplinary approach, the use of different eye assessment technology, and different management approaches; mainly contact lenses and surgery. Self-reported answers to an online survey (adapted to primary eye care) distributed via a newsletter emailed by various professional organisations across 15 Latin American countries were assessed and compared with those previously reported in three European countries. Answers from 977 eye care practitioners (60%) with >10 years of experience (396 in Latin America and 581 in Europe) were assessed. A total of 65.9% of Latin American responders prescribed rigid corneal lenses (RCL), although more than half of the respondents (54.0%) would fit more RCL if they underwent further training in RCL fitting. A majority of Latin American practitioners (74.0%) considered that RCL fitting is more difficult in keratoconus, requiring more diagnostic lenses (4.6 ± 2.7; median 4; range 1-10) than are necessary for healthy eyes. Low availability of corneal topography was reported in Latin America (23%), although practitioners with topographers are more likely to prescribe RCL (92.3%) and detect more new patients with keratoconus per year (83.5%). A minority of respondents referred keratoconus patients to another optometrist (25.8%) or (40.4%) participated in comanagement with ophthalmologists. This study provides initial evidence regarding keratoconus management in Latin America and suggests that actions are necessary to improve RCL training, facilitate eye-care technology accessibility and encourage comanagement between eye care practitioners to minimise disease progression and their impact on patients' quality of life in Latin America. [ABSTRACT FROM AUTHOR]

Myopia is a leading cause of visual impairment worldwide, and myopia progression in young adulthood may worsen this public health issue. The aim was to describe the changes in myopia and various ocular biometry parameters, and to determine the incidence and related factors of myopic shift among young adults in China. This 2-year prospective cohort study was conducted at the Zhongshan Ophthalmic Center, Sun Yet-san University, China. A total of 291 Chinese medical freshmen (314 enrolled at baseline) were followed over 2 years. The participants underwent detailed eye examinations at baseline and follow-up visits, including cycloplegic refraction, ocular biometry measurements, and swept-source optical coherence tomography. Visual fatigue was assessed with the Convergence Insufficiency Symptom Survey (CISS) using Rasch analysis. Questionnaire on eye care habits and physical activities was administered. A total of 291 study participants (baseline mean [SD] age, 18.7 [0.9] years; 132 [45.4%] male) were analysed. Seventy eight (26.8%) developed a myopic shift (defined as negative change in spherical equivalent worse than or equal to −0.50 D) over a 2-year period. The magnitude of subfoveal choroidal thinning was greater in participants with myopic shift, compared to those without. Axial length increased significantly by 0.12 mm in the group with myopic shift, compared to 0.02 mm in those without the myopic shift (p < 0.001) over 2 years. After multivariable adjustment, visual fatigue (using CISS) was found to be associated with the myopic shift (p = 0.02). Approximately one in four Chinese medical students had a clinically significant myopic shift. Choroidal thinning and axial elongation were observed in young adults with myopic shift. Greater visual fatigue score at baseline was associated with myopic shift after multivariable adjustment. [ABSTRACT FROM AUTHOR]

Homeless populations have lower health indicators, including in eye care. Few data exist on the levels and causes of visual impairment in Canadian homeless populations, and none in Montreal. This study aims to characterise the causes and levels of visual impairment, as well as eye care services utilisation among the Montreal homeless. Using random sampling, five homeless shelters were selected. In each shelter, 20 participants were randomly selected. After obtaining informed consent, participants completed an ocular examination, which included: presenting visual acuity (pinhole as needed), intraocular pressure, confrontation visual field, dilated fundus examination, post-dilation autorefraction and questionnaire on social determinants of health. A total of 95 participants were examined, of which 97.9% were male. The median age was 49 years old (interquartile range 38–56.5). The age-adjusted prevalence of visual impairment (presenting visual acuity <6/12) was 23.6% (95% CI 15.1–32.9) compared to 6.0% in the Canadian population (Z = 77.9, p < 0.0001). With pinhole correction, the prevalence of visual impairment dropped to 5.8% (95% CI 1.7–11.8). Prevalence was 8.2% (95% CI 3.7–15.9) for cataracts, 11.4% (95% CI 5.9–19.7) for glaucoma or suspects and 4.7% (95% CI 1.7–11.9) for diabetic retinopathy. Lastly, 18.9% of participants had an ocular examination within the last year compared to 41.4% in Canada (Z = −4.5, p < 0.0001) and 13.7% had never had a comprehensive eye examination. This sample population shows a prevalence of visual impairment which is four times that of the general Canadian population, with highly prevalent uncorrected refractive error, while accessing primary eye care twice less often. [ABSTRACT FROM AUTHOR]

This paper provides eye care practitioners with important information about the potential side effects of 0.01% atropine. Eye care practitioners routinely administer 0.01% atropine eye drops nightly to slow the progression of myopia, but nobody has assessed accommodative lag or facility, near phoria, intraocular pressure or comfort of drop administration. All 21- to 30-year-old adults with no history of accommodative issues or therapy were eligible. During the baseline visit, participants underwent testing related to potential side effects. Participants then administered one drop of 0.01% atropine nightly to both eyes, and all tests were repeated 1 week later. The average ± standard deviation age of the 31 participants was 23.9 ± 1.6 years, 71% were female, and 81% were Caucasian. The only significant changes were an increase in photopic pupil size from 4.9 ± 0.8 at baseline to 5.1 ± 0.6 mm after 1 week (paired sample t-test, p = 0.002) and an increase of the average intraocular pressure of the two eyes from 15.6 ± 2.7 to 16.7 ± 3.1 mmHg (paired-sample t-test, p = 0.003), but neither of these changes was clinically meaningful. There were no other statistically significant differences before and after 1-week administration of 0.01% atropine for any of the vision, accommodation, reading speed or subjective side effects. When asked how likely they would be to take the atropine drops to delay the onset of myopia on a scale from 1 (definitely not) to 10 (definitely would), participants replied with an average of 8.2 ± 2.0 after taking atropine eye drops for 1 week (paired-sample t-test, p = 0.81). Nightly administration of 0.01% atropine did not result in any clinically meaningful symptoms, so patients would be very likely to take the drops to delay the onset of myopia. [ABSTRACT FROM AUTHOR]

Current levels of appropriateness for primary diabetic eyecare delivered by Australian optometrists are presented along with realistic targets (benchmarks) for quality improvement. The demonstrated methods can be used in practice evaluation and benchmarking of other clinical practice areas and settings. To examine the appropriateness of diabetic eye-care delivery and establish achievable benchmarks of care (ABCs) for optometry practices in Australia. In a retrospective audit, clinical records of patients with type-II diabetes obtained from a randomly selected nationally representative sample of optometry practices were assessed against evidence-based clinical indicators. Appropriate care is defined as care delivered in compliance with the indicators. The ABC for each indicator was calculated as the average performance for the top 10% of optometry practices after Bayesian adjustment to account for a low number of eligible records. The audit of 420 randomly selected patient records from 42 practices against 12 clinical indicators showed an overall appropriateness of 69% (95% confidence interval (CI) 66%, 73%) for overall diabetic eye care. While a high level of appropriateness was identified for recall period (93%, 95% CI 85%, 100%) and referral (100%, 95% CI 38%, 100%), larger gaps existed in history taking (46%, 95% CI 44%, 52%), dilated fundus examination (80%, 95% CI 76%, 84%) and iris examination (0%, 95% CI 0%, 56%). The ABCs for 8 of 12 indicators were 100%, and the remaining three indicators had ABCs above 80%. An ABC for the iris examination indicator could not be calculated owing to the low number of eligible patient record cards. This study demonstrated a systematic process of practice evaluation and benchmarking in optometry practices. The diabetic eye care delivered by Australian optometrists was largely appropriate; however, improvement opportunities exist for history taking and physical examination. The ABCs demonstrate that excellence in primary diabetic eye care is attainable and will serve as an important tool in future initiatives to reduce the identified evidence-to-practice gaps. [ABSTRACT FROM AUTHOR]

To describe demographic and clinical characteristics as well as etiologies and visual outcomes of patients with scleritis. This is a descriptive, observational and retrospective study. We reviewed the electronic health records of patients with diagnosis of scleritis, who presented at the Institute of Ophthalmology Conde de Valenciana from January 2009 to December 2019. The cohort consisted of 162 patients with mean follow-up of 33.7 months. Mean age of scleritis presentation was 53.8 years. The most common type of scleritis was anterior nodular in 67 patients (41.3%). Most cases were idiopathic (52.4%). Visual outcomes were worse in anterior necrotizing scleritis. The most used drugs were oral NSAIDs and corticosteroids. The visual outcome in most patients is favorable, however it depends on scleritis type and etiology, with worse prognosis in anterior necrotizing scleritis forms and associated with autoimmune or systemic diseases. [ABSTRACT FROM AUTHOR]

School eye screening is a crucial strategy in the elimination of childhood blindness because of its ability to reach out to children who are otherwise inaccessible to eye care needs. Comprehensive screening programs are recommended and are beneficial, but the economic aspects of such models remain to be understood. This study aimed to analyse the cost of a comprehensive school eye screening model while utilizing optometrists and optometry students. This cross-sectional study was conducted for 295 schools screened in the academic year 2018–2019. The analysis was performed from the service provider's perspective including only the direct costs. Financial records were used for cost estimates. The outcome measures were cost per school and child, predictors for the cost, DALYs averted, cost of childhood blindness, and Benefit–Cost Ratio. A total of 65 094 children underwent screening from 295 schools. The median (IQR) cost per school and child for screening was $29.65 (29.65–44.34) and $0.66 (0.32–1.13). The regression model predicted that the cost of screening was dependent on school strength, number of screening personnel, distance of the schools, and deliverables. With the interventions to improve compliance, 14686.30 DALYs have been averted. Loss of productivity due to childhood blindness was estimated to be $339070.83. Screening for colour vision also had a Benefit–Cost ratio of greater than one. Cost of screening was low and the benefits were high while utilising optometrist and optometry students along with a comprehensive screening protocol. [ABSTRACT FROM AUTHOR]

To investigate factors associated with prolonged length of stay and high cost among pediatric hospitalizations with a primary ophthalmic diagnosis. This retrospective, cross-sectional study utilized data on pediatric admissions with a primary ophthalmic diagnosis from the multicenter 2016 Kids' Inpatient Database. Multivariable logistic regression models adjusted for demographic, hospital, and admission characteristics were used to evaluate factors associated with prolonged stay and high cost, defined as exceeding the 75th percentile (>4 days and $12,642, respectively). An estimated 6,811 pediatric hospitalizations with a primary ophthalmic diagnosis in the United States in 2016 were included. On adjusted analysis, a prolonged length of stay was more likely with Medicaid (vs. private insurance, OR = 1.19, 95% CI: [1.02, 1.40], p =.03), non-trauma (vs. trauma, OR = 2.77, 95% CI: [2.12, 3.63], p <.001) and urban teaching hospitals (vs. rural, OR = 3.48, 95% CI: [1.04, 11.69], p =.04). A high cost of stay was more likely with higher income levels (Quartile 3 vs. 1, OR = 1.30, 95% CI: [1.02, 1.67], p =.04; Quartile 4 vs. 1, OR = 1.49, 95% CI: [1.08, 2.05], p =.02), private insurance (vs. Medicaid, OR = 1.26, 95% CI: [1.04, 1.53], p =.02), Western hospitals (vs. South, OR = 2.74, 95% CI: [1.83, 4.12], p <.001), and trauma (vs. non-trauma, OR = 3.29, 95% CI: [2.57, 4.21], p <.001). Children and young adults had higher odds of prolonged stay, while adolescents and young adults had higher odds of high cost compared to toddlers (p <.05 for all). Additional work addressing the factors associated with higher resource utilization may help promote the delivery of quality inpatient pediatric eye care. [ABSTRACT FROM AUTHOR]

Keywords: Health care utilization; racial disparities; Native Hawaiians and Pacific Islanders; National Health Interview Survey; health care access EN Health care utilization racial disparities Native Hawaiians and Pacific Islanders National Health Interview Survey health care access 203 207 5 03/08/23 20230401 NES 230401 Native Hawaiians and Pacific Islanders (NHPIs) are a poorly studied population in the United States (US) with high rates of obesity, diabetes and cardiovascular disease that place them at risk for vision loss.[1] Most major guidelines recommend dilated eye examinations at regular intervals - depending on patient age and other risk factors - to identify and treat ocular disease, especially among populations at higher risk for vision loss.[2] However, there is a paucity of research on eye care utilization by NHPIs due to their smaller population size and frequent aggregation with Asian Americans.[3] This study identified the rate and correlates of eye care utilization among NHPIs in the US. NHPIs had lower rates of eye care utilization than their non-NHPI counterparts across most ages, both sexes, all income levels, and all insurance statuses. Families with higher income can afford to spend more on eye care.[7] Older adults have a higher incidence of eye disease and vision impairment, which may increase their eye care utilization.[7] However, even higher income, older and vision impaired NHPIs had lower eye care utilization rates than their non-NHPI counterparts. [Extracted from the article]

To develop a simple but more precise model to calculate potential annual productivity losses due to blindness and moderate and severe vision impairment (MSVI) at the national, regional, and global level. Productivity loss was defined as the loss of minimum wage/Gross National Income per capita (GNI) incurred by people aged 50–64 years with blindness or MSVI, who were not able to work or worked with reduced earnings in 2020. We developed a global list of minimum wage data from on-line sources. All other model data were sourced from international, standardised, and open-access databases. For blindness, the total productivity loss (not working) incurred by 64%–90% of the affected population was summed up with partial productivity loss, defined as 10%–36% of the affected population earning one-third of that of the sighted population. For MSVI, the total productivity loss for 30%–55% of the affected population was summed with the partial productivity loss, defined as 45%–70% of the affected population having 35% reduced earnings. The costs of blindness and MSVI were summed to obtain the cost of combined vision loss. The global cost of vision loss based on minimum wage was US$160-US$216.32 billion for 2020. The global cost of vision loss using GNI was US$449.36-US$584.66 billion. A parsimonious model that considers minimum wage and GNI potentially lost due to blindness and MSVI can be used for eye care programming planning and advocacy at the national, regional, and global level. [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]

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

Inadequate public knowledge about eyes and eye care poses avoidable risks to vision-related quality of life. This study of eye care knowledge among Canadians extends earlier findings from focus groups. 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. 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. Vision-threatening knowledge gaps and misinformation about eyes and eye care among Canadian respondents highlight the need for accessible, targeted public education. [ABSTRACT FROM AUTHOR]

This study described the clinical presentations and proposed a diagnostic algorithm of fungal orbital infections based on 20 years of experience in a tertiary eye care center in Egypt. Medical Records of cases with orbital fungal infection from January 2000 to December 2019 were reviewed. The study included 45 patients. Mucormycosis was proven in 32 (71.1%) and aspergillosis in 13 (28.9%) patients. Thirty-five (77.8%) patients had predisposing factors mainly uncontrolled diabetes. Twenty-seven (60%) patients presented with orbital apex syndrome, 10 (22.2%) with orbital cellulitis and 8 (17.7%) with proptosis. The prognosis was generally poor (31.1% mortality, 8.88% exenteration and 11.1% self-evisceration). The proposed algorithm composed of six atypical clinical presentations mainly acute orbital apex and fulminating orbital cellulitis plus any radiological or microbiological findings. The proposed algorithm markedly reduced the complications after 5 years of the study. Once fungal orbital infection is suspected, treatment should start immediately. [ABSTRACT FROM AUTHOR]

To analyse the effect of the state screening program for glaucoma, funded by the Kazakhstan State programs for the health care system "Salamatty Kazakhstan" (2011-2015) and "Densaulyk" (2016-2019), on glaucoma diagnosis. This study involved 1,620,658 men and women 40-70 years of age. State screening for glaucoma includes measures of intraocular pressure (IOP) and corneal thickness. Data for glaucoma incidence were retrieved from the state statistics dataset. Studies of vulnerable age groups and ophthalmologists' availabilities were assessed, and correlations with glaucoma detection were determined. For the statistical analysis, MATLAB application package version R2017b (MathWorks, USA) was used. The number of registered glaucoma patients was 43,337 in 2010. In 2016, following the screening program, this figure increased to 68,195. A 49% increase in newly identified glaucoma cases from 70.8 (in 2010) to 124 (in 2016) per 100,000 population was determined. Thus, the sufficiency and effectiveness of the screening program were confirmed by the increase in the number of patients diagnosed with glaucoma, which also depended on age. A correlation between suspected glaucoma and age groups was exposed with the observation of a high number of cases in the older population. The state screening programs for glaucoma in the Republic of Kazakhstan constitute initial steps in the prevention of irreversible blindness and disability due to glaucoma. Such screening seems to allow timely and adequate diagnosis of the disease in people>40 years of age. * The implementation of the Kazakhstan State programs for the health care system "Salamatty Kazakhstan" (2011-2015) and "Densaulyk" (2016-2019) enabled the detection of glaucoma cases in Kazakhstan of the population aged over 40 years. * Education of the population about the prevention and treatment of glaucoma has a vital role in lowering the cases of this socially significant pathology. * Increasing the number of eye care specialists and implementing high-tech diagnostic tools will be the main steps in the strategy for early detection of glaucoma. Subjects: Epidemiology; Health Informatics and Statistics; Ophthalmology [ABSTRACT FROM AUTHOR]

Traditional medicines are commonly used throughout the world, especially in Africa. About 13.2-82.3% of the population uses traditional eye medicine. These are forms of biologically based therapies, practices, or partially processed agents that are applied to the eye or administered orally to achieve a desired ocular therapeutic effect. To determine the prevalence and associated factors of traditional eye medicine use among adult ophthalmic patients attending the University of Gondar Comprehensive Specialized Hospital-Tertiary Eye Care and Training Center, Northwest Ethiopia, 2020. A cross-sectional study within the hospital was conducted on 502 newly admitted adult ophthalmic patients who were selected by using a systemic random sampling method from August 15 to 21 October 2020. Of the total (502) subjects, 93.1% of subjects participated in the study. From the total participants, 22.31% (112) (95% confidence interval (CI: 19-26%)) used traditional eye medicine in the past two years. Positive family history of traditional eye medicine use (Adjusted odds ratio (AOR = 11.1 (95% CI: 4.8-25.6)), availability of traditional healers (AOR = 3.7 (95% CI: 1.6-8.6)), residency in the rural (AOR = 24.9 (95% CI: 10.4-59.7)), family income of 300-1,500 adjusted odds ratio (AOR) = 6.6 (95% CI: 1.9-22.9)), and ≥ 6 months (AOR = 8.5 (95% CI: 3.02-23.7) were significantly associated with traditional eye medicine use The driving issues for using TEM were the availability and costs of modern medicine. The prevalence of TEM is higher than in the previous study conducted in Ethiopia. Subjects: Allied Health; Health & Society; Health Conditions; Nursing [ABSTRACT FROM AUTHOR]

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. 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. 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). 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. [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]

To describe the socioeconomic profile, awareness level and reasons for the delay in accessing timely eye care for cataract surgery in patients of lens-induced glaucoma (LIG). This cross-sectional observational study included all patients with LIG who presented to a tertiary eye care centre in central rural India between March 2019 to February 2020. Data were collected through a questionnaire. Out of the 731 patients included in the study, the majority were females (69.36%). The mean age of the patients at presentation was 62.66 ± 10.37 years. Only a few participants, 193 (26.40%) were aware of LIG. Lower socioeconomic profile, older age, female gender and illiteracy were found to be strongly associated with awareness about LIG (p <.001). Patients waiting for the winter season (58.27%) to get operated was the major reason for delayed presentation to the hospital. Other reasons for the delayed presentation were – need not felt (feeling that intervention was not necessary) due to good vision in other eye (14.36%), financial issues (11.63%), long travelling distance (7.11%), no caretaker (6.89%), medical illness (1.78%) and fear of surgery (0.55%). Delayed reporting for eye healthcare in patients of LIG is found to be multifactorial. Most patients preferred waiting for the winter season to get their eyes operated, which throws light on the mindset and ignorance of the patients in this part of central rural India. We further emphasize on strengthening the education and counseling efforts in the community to enable patients to access services in a timely fashion. [ABSTRACT FROM AUTHOR]

To study the clinical, microbiological profile and management outcomes of orbital abscess at a tertiary care center in South India. In a retrospective interventional case series, we reviewed all patients diagnosed with orbital cellulitis from 2000–2020. The data analyzed included demographic profile, clinical and radiological features, microbiological profile, and management outcome. A total of 921 cases of orbital and periorbital infections were reviewed. Seventy-two cases were diagnosed as orbital cellulitis. Thirty-four cases (47.22%) had radiological evidence of orbital abscess. The median age was 20.63 years. Three patients (8.82%) were neonates. A male preponderance was noted (23, 67.65%). Sinusitis (10, 29.41%) and diabetes (5, 14.7%), were the most common predisposing factors. Optic neuropathy was seen in 15 (44.11%) patients, cavernous sinus thrombosis in two patients (5.88%), and septicemia in one patient (2.94%) Multiple orbital abscesses were noted in 7 (20.59%) cases. All patients underwent surgical drainage. Methicillin-sensitive Staphylococcus aureus was the most common organism isolated in 14 patients (41.18%). Vision improvement or stabilization was seen in all except 3 (8.82%) Orbital abscess is a potential sight-threatening orbital infection. The infective process can spread and ascend up to involve cavernous sinus thereby becoming life-threatening. A timely diagnosis and intervention can halt the disease process and help restore vision in many cases. [ABSTRACT FROM AUTHOR]

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]

The aim of this study was to determine the clinical presentations of uveitis at the University of Gondar Tertiary Eye Care and Training Center, North-West Ethiopia. A cross sectional study was performed at the center from August 2017 to July 2018. Study patients underwent complete ophthalmic evaluation and relevant ancillary tests. Data was gathered using a data extraction format and analyzed. A total of 105 eyes of 82 patients were studied. The mean age was 33.8 ± 14.8 years,53 (65%) were male and uveitis was unilateral in 72%. Anterior uveitis was the commonest, 57%, followed by Intermediate uveitis 21.7%. Sixty-six of the 105 (63%) of eyes were blind. Cataract was the commonest complication identified. This study showed that uveitis is prevalent in the working age group with a significant number of blindness. Anterior uveitis was the commonest type of Uveitis and cataract was the commonest complication. [ABSTRACT FROM AUTHOR]

To report the pattern of noninfectious scleritis across a tertiary eye-care network. A three-year retrospective review of patients diagnosed with noninfectious scleritis was performed. Data were retrieved using diagnostic terms assigned to scleritis through the in-house eyeSmart-electronic medical record system. 1103 patients, with a mean age of 44.33 ± 14.38 years and a median follow-up of 199.5 days (range 32–685) were enrolled. Unilateral disease was noted in 85%. Diffuse anterior scleritis (n = 542, 42.51%) and nodular scleritis (n = 482, 38.12%) were the commonest subtypes. Systemic immune disease association was present in 65 (5.89%). Treatment at onset was topical corticosteroids (n = 372, 36.54%) followed by oral non-steroidal anti-inflammatory drugs (n = 351, 34.45%), oral corticosteroids in 184 (19.04%), and immunomodulators in 32 patients (3.54%). This study depicts the pattern of various noninfectious scleritis in a large cohort of patients. The present study helped to further customize the electronic medical records to minimize several data capture limitations. [ABSTRACT FROM AUTHOR]

To determine the prevalence of cataract and its relationship with some determinants in individuals above 60 years. Of 3792 subjects that were invited, 3310 participated in the study (response rate = 87.31%). All subjects underwent full optometric, slit lamp, and fundoscopic examinations. Then, their lenses were evaluated according to the World Health Organization cataract grading system after pupil dilation. Age- and sex-standardized prevalence with 95% confidence interval (CI) of nuclear, cortical, posterior subcapsular cataracts (PSC), any type cataract, and all lens change was 53.09% (49.80 to 56.35), 23.02% (20.87 to 25.32), 5.57% (4.62 to 6.70), 58.78% (55.65 to 61.83), and 72.49% (70.14 to 74.71), respectively. Any type, nuclear, cortical, and PSC cataracts, had a positive association with age and an inverse association with education. Moreover, the prevalence of cortical and PSC cataract had an inverse association with economic status. Among all variables, age was the strongest determinant for cataract and its subtype. This study found a higher prevalence of cataract compared to some previous studies such that about two-thirds of the geriatric population had cataract in the past or at the time of the study. Considering the association of cataract with variables such as economic status and education level, it seems that training and increased awareness and knowledge of the elderly population regarding the importance of eye care by physicians plays an important role in reducing the burden of cataract. [ABSTRACT FROM AUTHOR]

Structured record keeping improves documentation in age-related macular degeneration; however, it may have a more limited effect on the management decisions of a group of already highly trained clinicians, especially in the context of other well-embedded clinical decision support tools. Structured record keeping has been associated with a range of advantages including improved history taking and communication, reduced number of unnecessary referrals, and enhanced diagnostic accuracy. The aim of this study was to examine the impact of a structured record keeping, quality improvement tool on recording, reporting and management congruency. A before and after retrospective record review study was performed in a single academic, intermediate-tier care institute in New South Wales, Australia. The structured record keeping tool intervention captured 31 items in addition to the prior pre-existing medical record: six items relating to historical risk factors, two items relating to patient activation, 13 items signifying core clinical signs, five items for change analysis and five items regarding the ongoing patient management plan. Two hundred medical records from 151 patients with age-related macular degeneration were analysed. There was a statistically significant improvement in the number of reports that explicitly specified the number of clinical structural risk factors (from 24 to 75%; Fisher's exact p < 0.001) and risk of progression to advanced disease (from 71 to 84%; p = 0.041); however, this documentation had no statistically significant effect on the report-recommended management plan and/or the final report-recommended review period. Disease-specific, structured record keeping improves the outgoing documentation of key clinical signs and is effective in prompting the transposition of these signs into a quantified risk progression score. It has limited value in improving management consistency among a group of highly trained eye care staff. [ABSTRACT FROM AUTHOR]