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OBJECTIVE: To assess self-reported awareness of diabetic retinopathy (DR) and concordance of eye examination follow-up compared with findings from concurrent retinal images. RESEARCH DESIGN AND METHODS: We conducted a prospective observational 10-year study of 26,876 consecutive patients with diabetes who underwent retinal imaging during an endocrinology visit. Awareness and concordance were evaluated using questionnaires and retinal imaging. RESULTS: Awareness information and gradable images were available in 25,360 patients (94.3%). Severity of DR by imaging was as follows: no DR (n = 14,317; 56.5%), mild DR (n = 6,805; 26.8%), or vision-threatening DR (vtDR; n = 4,238; 16.7%). In the no, mild, and vtDR groups, 96.7%, 88.5%, and 54.9% of patients, respectively, reported being unaware of any prior DR. When DR was present, reporting no prior DR was associated with shorter diabetes duration, milder DR, last eye examination >1 year before, no dilation, no scheduled appointment, and less specialized provider (all P < 0.001). Among patients with vtDR, 41.2%, 58.1%, and 64.2% did not report being aware of any DR and follow-up was concordant with current DR severity in 66.7%, 41.3%, and 25.4% (P < 0.001) of patients when prior examination was performed by a retinal specialist, nonretinal ophthalmologist, or optometrist (P < 0.001), respectively. CONCLUSIONS: Substantial discrepancies exist between DR presence, patient awareness, and concordance of follow-up across all DR severity levels. These discrepancies are present across all eye care provider types, with the magnitude influenced by provider type. Therefore, patient self-report should not be relied upon to reflect DR status. Modification of medical care and education models may be necessary to enhance retention of ophthalmic knowledge in patients with diabetes and ensure accurate communication between all health care providers. [ABSTRACT FROM AUTHOR]

Background: People with a learning disability experience challenges accessing primary health care services, including eye care services. Methods: Eye care needs of people with a learning disability, and how well they are met by existing services in England, were explored. Barriers and enablers to accessing these services were investigated. This was informed by a scoping review of the literature and a historic literature library. Findings: Adults with a learning disability are 10 times more likely than other adults to have a serious sight problem and children with learning disabilities are 28 times more likely. There is good evidence of high levels of unmet eye care need special schools in England with over 4 in 10 children attending having no history of any eye care. Conclusion: The authors discuss possible systemic changes to address these inequalities in England. These include automatic entitlement to an NHS sight test annually, specialist pathways in community opticians, eye care services in special schools, and peer to peer and peer to professional promotion of services by people with lived experience. Dedicated care pathways have improved uptake of services in other areas of primary care. Research into the effectiveness of lived experience eye health advocacy is needed. Accessible summaries: People with learning disabilities are much more likely to have sight problems but much less likely to get the eye care they need.Everyone should be able to access good eye care.Not getting good eye care puts eyesight at risk and existing problems might not be discovered.We look at what helps people get better eye care and what stops people from getting it.We found that improving awareness, better staff training and good communication are important.Special eye care services for people with learning disabilities have been designed but are not available in much of the UK. Having these specialist services across nations would help more people get the eye care they need. [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]

Purpose: To describe the benefits of optometric evaluation for detection of vision-affecting conditions in the context of community-based eye health screenings and identify factors associated with having a recent dilated eye exam. Methods: Enrolled participants were age 40 and older, living independently in affordable housing developments in New York City. Eye health screening failure and criteria for seeing the on-site study optometrist were defined as visual acuity 20/40 or worse in either eye, intraocular pressure 23–29 mmHg, or an unreadable fundus image. The optometrist conducted a manifest refraction using loose lenses and used a portable slit lamp and ophthalmoscope to perform a non-dilated anterior and posterior segment ocular health evaluation. Demographics, social determinants of health, eye health screening results, and rates of suspected ophthalmic conditions were recorded. To determine factors associated with having a recent dilated eye exam, which was the main outcome for this statistical analysis, a stepwise multivariate logistic regression was performed. Results: A total of 708 participants were screened, 308 attended the optometric exam; mean age 70.7 ± 11.7 [standard deviation (SD)] years. Among this subgroup, 70.1% identified as female, 54.9% self-identified as African American, 39% as Hispanic/Latino, and 26.6% Dominican ethnicity; 78.2% (241/308) had not undergone a dilated eye exam within the last year, 71.4% reported they did not have an eye care provider. Stepwise multivariate logistic regression analysis indicated that participants who self-reported having cataracts (odds ratio (OR) 2.15; 95% confidence interval (CI) 1.03–4.47; p = 0.041), self-reported having glaucoma/glaucoma suspect (OR 5.60; 95% CI 2.02–15.43; p = 0.001), or spoke Spanish as their primary language (OR 3.25; 95% CI 1.48–7.11; p = 0.003) had higher odds of having a recent dilated eye exam. Conclusions: This community-based screening initiative demonstrated the effectiveness of optometric exams in detecting vision-affecting conditions and identified factors associated with having a recent dilated eye exam. Optometrists play a vital role in increasing access to eye care for high-risk, underserved populations. Trial registration: ClinicalTrials.gov (NCT04271709). [ABSTRACT FROM AUTHOR]

Purpose: To assess the presence and severity of acquired blepharoptosis (ptosis) among patients visiting an eye care clinic and the receptivity of eligible patients to pharmacologic treatment with oxymetazoline 0.1% ophthalmic solution. Patients and Methods: Patients aged 50 years or older who had a scheduled clinic appointment for any reason (eg, dry eye, cataract surgery consultation) were asked to respond to written questions about lid position and select whether their upper lid position most closely matched one of 4 images shown to them corresponding to no, mild, moderate, or severe ptosis. Patients selecting any of the mild, moderate, or severe ptosis were offered treatment with oxymetazoline 0.1% ophthalmic solution, barring any medical contraindications. The outcome measures were the proportion of patients with each self-reported lid position level (none to severe ptosis), the proportion of patients with asymmetric ptosis, and the proportion of patients willing to accept the treatment. Results: Data for 188 eyes of 94 patients were analyzed. Overall, 73.4% of patients had ptosis in at least one eye, and 25.5% had an asymmetric upper eyelid presentation. The proportions of patients with self-reported mild, moderate, or severe ptosis in at least one eye were 41.5%, 25.5%, and 6.4%, respectively. Among those patients eligible for treatment, 19.7% were willing to accept the treatment. Conclusion: Based on patients' self-assessment of lid position, this study suggests a higher prevalence of ptosis than reported previously. Evaluation of the eyelids should be a standard part of the comprehensive eye examination. [ABSTRACT FROM AUTHOR]

Eye care programs, in developing countries, are often planned using the prevalence of blindness and visual impairment, often estimated from Rapid Assessment of Avoidable Blindness (RAAB) surveys. A limitation of this planning approach is that it ignores the annual overall eye care requirements for a given population. Moreover, targets set are arbitrary, often influenced by capacity rather than need. To address this lacunae, we implemented a novel study design to estimate the annual need for comprehensive eye care in a 1.2 million populations. We conducted a population based longitudinal study in Theni district, Tamil Nadu, India. All permanent residents of all ages were included. We conducted the study in three phases, (i) household level enumeration and enrollment, (ii) basic eye examination (BEE) at household one year post enrollment, and (iii) assessment of eye care utilization and full eye examination (FEE) at central locations. All people aged 40 years and above were invited to the FEE. Those aged <40 years were invited to the FEE if indicated. In the main study, we enrolled 24,327 subjects (58% aged below 40 years and 42% aged 40 years and above). Of those less than 40 years, 72% completed the BEE, of whom 20% were referred for FEE at central location. Of the people aged ≥40 years, 70% underwent FEE. Our study design provides insights for appropriate long term public health intervention planning, resource allocation, effective service delivery, and designing of eye care services for resource limited settings. [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]

Purpose: Research suggests that there are challenges in the accessibility of eye care for children in England. This study explores the barriers and enablers to eye examinations for children under 5 years of age from the perspective of community optometrists in England. Methods: Optometrists working in community settings were invited to participate in virtual focus group discussions using an online platform based on a topic guide. The discussions were audio‐recorded, transcribed and thematically analysed. Themes were derived from the focus group data based on the study aim and research question. Results: Thirty optometrists participated in the focus group discussions. The overarching themes identified as barriers to eye examinations for young children in a community setting were as follows: 'Time and Money', 'Knowledge, Skills and Confidence', 'Awareness and Communication', 'Range of Attitudes' and 'Clinical Setting'. The key themes for enabling eye examinations for young children were as follows: 'Improving behaviour', 'Enhancing training and education', 'Enhancing eye care services', 'Raising awareness', 'Changes in professional bodies' and 'Balancing commercial pressures and health care'. Conclusion: Time, money, training and equipment are perceived by optometrists as key factors in providing an eye examination for a young child. This study identified a need for improved training and robust governance related to eye examinations for young children. There is a need for change within eye care service delivery such that all children, regardless of age and ability, are examined regularly, and by conducting these examinations, optometrists remain confident. [ABSTRACT FROM AUTHOR]

Purpose: The effects of diabetes mellitus (DM) on visual function have been extensively studied. Fewer studies evaluate the effect of visual function on DM, and previous small studies have shown mixed results concerning the relationship between glycated hemoglobin (HbA1c) and cataract surgery. We performed a retrospective, observational, single-site study at a Veterans hospital to evaluate this relationship and the relationship between HbA1c and non-surgical eye care. Patients and Methods: We compared pre- and post-operative/examination HbA1c in 431 surgical and 431 matched, non-surgical subjects who underwent eye examination at the same institution. Subgroup analysis was performed by age, elevated (≥ 8) pre-operative/examination HbA1c, and change in diabetic management. We also assessed for a relationship between changes in best-corrected visual acuity (BCVA) and HbA1c. The Minneapolis Veterans Affairs Health Care System Research Administration determined this study to be Institutional Review Board exempt from the requirements of 38 CFR 16 under Category 4 (iii). Results: Pairwise comparison of pre- versus post-operative HbA1c trended towards reduction at 3– 6 months in all surgical subjects, with a statistically significant reduction in older subjects, and those with higher pre-operative HbA1c. Eye examination subjects experienced a significant HbA1c reduction 3– 6 months after eye examination. Reduction in post-operative/examination HbA1c was associated with concurrent change in diabetic management. Conclusion: We found an overall reduction in HbA1c in diabetic Veterans who interacted with an ophthalmologist, whether for cataract surgery or eye examination. HbA1c reduction was greatest when ophthalmic care was delivered as part of a multidisciplinary care team. Our findings add new evidence to further support the importance of ophthalmic care in patients with DM and suggest improved visual function may facilitate improved glycemic control. [ABSTRACT FROM AUTHOR]

BACKGROUND: In 2012, Chicago Public Schools and the Chicago Department of Public Health partnered together to create the Chicago School‐Based Vision Program (CSBVP). This ongoing, city‐wide program provides school‐based vision services (eye examinations, eyeglasses provision, and eye care referrals) to students with limited access. METHODS: Descriptive analysis of the program operations from 2012 to 2020, including number of students served and exam findings during 2017‐2020, as well as lessons learned and recommendations for reproducing the successes of the CSBVP in other contexts. RESULTS: During its first 8 years, the CSBVP provided eye examinations to over 350,000 students. During the years 2017‐2020, this included 126,238 eye exams and provision of eyeglasses to 73,751 students. CONCLUSIONS: The CSBVP is built upon strong community and school relationships. The program offers vision services, equitably, to all students across the district. The lessons learned through the implementation of the CSBVP may provide guidance for future district‐wide vision programs. [ABSTRACT FROM AUTHOR]

Introduction. A significant proportion of diabetic patients in the United States do not present for annual dilated eye exams to monitor for signs of diabetic retinopathy (DR). The purpose of this study was to analyze the results of a statewide, multiclinic teleretina program designed to screen rural Arkansans for this sight-debilitating disease. Methods. Patients with diabetes seen at 10 primary care clinics across Arkansas were offered teleretinal-imaging services. Images were transmitted to the University of Arkansas for Medical Sciences' (UAMS) Harvey and Bernice Jones Eye Institute (JEI) for grading and recommendations for further treatment. Results. From February 2019 to May 2022, 668 patients underwent imaging; 645 images were deemed of sufficient quality to generate an interpretation. 541 patients had no evidence of DR, while 104 patients had some evidence of DR. 587 patients had no evidence of maculopathy, while 58 patients had some evidence of maculopathy on imaging. 246 patients had other pathology evident on imaging, with the most common being hypertensive retinopathy, glaucoma suspects, and cataracts. Discussion. In a rural, primary care setting, the JEI teleretina program identifies DR and other nondiabetic ocular pathologies, allowing for an appropriate triage for eye care for patients in a predominantly rural state. [ABSTRACT FROM AUTHOR]

Objective: This survey determined the utilisation of eye care services and associated factors among adults in the Ashanti region of Ghana. Design: A population-based cross-sectional descriptive study. Method: Data for this study was collected from 1615 randomly selected individuals in the Ashanti region of Ghana, using a structured, pretested interviewer-guided questionnaire. Information regarding the accessibility and determinants of, and barriers to, eye care services was based on self-reports, using the WHO Eye Care Services Assessment Questionnaire. Inferential analyses were performed using the chi-square test for statistical significance, set at p=0.05. Setting: Ashanti Region, Ghana. Participants: One thousand six hundred and fifteen randomly selected adults. Results: Public eye care facilities were used by 58.2% of the participants for their last eye exam. Of the participants, 47.0% had travelled less than five kilometres for their last eye exam. Waiting time and service cost were participants' most frequently cited challenges in seeking care. No need felt (40.1%), self-medication (37.7%) and cost (22.2%) were the most frequently mentioned barriers to seeking ophthalmic services. Conclusion: The major challenges encountered in seeking eye care services were waiting time and cost of service. Major barriers to ophthalmic services utilisation were no need felt, self-medication and cost. Factors such as cost, lack of felt need and self-medication, which serve as barriers to utilising eye care services, should be addressed by stakeholders through eye health education and promotion. [ABSTRACT FROM AUTHOR]

Purpose: India has the largest population of youth in the world, thereby making them important contributors to the "India of Tomorrow". Over 80% of knowledge gained is by the visual sense, thereby making school screening programs a necessity in our country. Data from the pre-COVID era, that is, 2017–18 was collected from close to 19,000 children in Gurugram, Haryana, a tier two city in National Capital Region, India. A similar prospective observational study is planned post COVID-19 (2022–23) for further analysis to depict the impact of COVID-19 in these areas. Methods: The program They See, They Learn was set at government schools in the area of operations (district of Gurgaon, Haryana), where the children and their families were unable to afford eye care services. All children who were screened underwent a comprehensive eye examination at the school premises itself. Results: A total of 18,939 students were screened over a period of 18 months, covering a total of 39 schools in the Gurugram belt, in the first phase of the program. Eleven point eight percent (n = 2254) of all school students had some form of refractive error. Girl students were found to have a higher refractive error rate (13.3%) compared to boy students (10.1%) across the schools screened. Myopia was the most common type of refractive error. Conclusion: School students require perfect vision or else they can be discouraged and may become a major burden to the economy of any developing nation. A school screening program aiming at populations that cannot afford such basic needs like spectacles is a must in all zones of the country. [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]

Introduction: Social determinants of health can limit access to regular eye care, but their role in ophthalmology is underexamined. The purpose of this study is to assess the relationship between patient characteristics and self-reported barriers to eye care. Methods: This anonymous, cross-sectional survey was conducted at a 2-day free eye clinic event in Pittsburgh, Pennsylvania. Adult patients presenting for vision screening were eligible to participate. Patient characteristics (demographics, health status) and self-reported barriers to eye care were collected. Predictors of barriers to eye care were analyzed using binary logistic regression. Results: Of 269 eligible, consecutive patients approached for survey completion, 183 comprised the volunteer sample. The 183 participants (105 female patients [59%]) had a mean (standard deviation) age of 53 (15) years and generally self-identified as Black (74, 46%) or White (67, 41%). While a third reported having no health insurance (60, 34%), the remaining two-thirds of participants had public (84, 48%) or private coverage (34, 19%). Three-quarters of respondents reported at least one barrier to receiving regular eye care (136, 76%), most commonly medical costs (89, 50%) and insurance issues (73, 41%). Not having health insurance or vision insurance was strongly associated with reporting at least one barrier to care (OR: 5.00, p = 0.002, and OR: 7.46, p < 0.001, respectively). Those with self-reported eye disease were more likely to report transportation difficulties (OR: 4.45, p = 0.013), and employed participants reported difficulty getting time off work to attend eye exams (OR: 7.73, p = 0.002). Finally, compared to Black race, White race was associated with a higher likelihood of reporting any barrier to care (OR: 2.79, p = 0.013). Conclusion: Three-quarters of vision screening attendees reported at least one barrier to regular eye care, most commonly medical costs and insurance. [ABSTRACT FROM AUTHOR]

The trisomy of chromosome 21, the smallest autosome, is associated with significant systemic manifestations in addition to intellectual disability. The triplication of this chromosome, known as Down syndrome (DS) is also associated with several manifestations in the eye, and ocular adnexae. People with DS have a variety of ophthalmic conditions, some of which require intervention. The variable systemic and ophthalmic presentations in DS can make the delivery of eye care challenging. We highlight common ophthalmic presentations in people with DS, as well as the practical implications of delivering eye examinations for this complex needs population. We aim to aid clinicians involved in the ophthalmic care of people with DS in both clinical and research settings. [ABSTRACT FROM AUTHOR]

To explore the relationship between binocular imbalance (BI) and the abnormal development of binocular refraction. BI data were collected by enrolling the first 1,000 adolescents and children aged 6–18 years in Shenzhen Eye Hospital from April 2020 to January 2021. In this cross-sectional study, the imbalance value (IV) did not show a statistical correlation with the spherical equivalent (SE) (oculus dexter [OD]: r = 0.022, p = 0.586; oculus sinister [OS]: r = −0.021, p = 0.606), and had little correlation with the uncorrected visual acuity (VA) (OD: r = −0.084, p = 0.039; OS: r = −0.034, p = 0.408). The proportion of binocular contrast imbalance (BCI) (the absolute value) maintained the highest level (from 54.42 to 79.17 percent) with the increase of bilateral SE difference in the four subcategories (binocular balance, monocular suppression, binocular rivalry, and BCI). From −100 to +100 of IV, the SE of the left eye tends to increase negatively when compared with the right eye (from −95 < IV ≦ −80, SE difference = −0.83 ± 1.58, to −20 < IV ≦ −10, SE difference = −0.14 ± 0.61; from 10 ≦ IV <20, SE difference = −0.05 ± 0.80, to 80 ≦ IV <95, SE difference = 1.48 ± 2.77). BI widely exists within the general pediatric population. The BI did not show significant correlation with the unilateral eye refractive state and the VA. However, the BI may be accompanied by imbalanced development of the eye refractive system. Furthermore, the SE of the dominant eye (from the prospective of BI) tends to be more negative than that of the opposite eye as the value increases. Clinical Trial Registration number: ChiCTR2100045457. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to map evidence of eye care interventions in managing critical or surgical patients submitted to prone positions. Materials and method: This scoping review was prepared according to the Joanna Briggs Institute's methodology, following the PRISMA-ScR criteria. A search was conducted from July to August 2020 in the SCOPUS, Web of Science, Science Direct, PubMed Central, CINAHL, and COCHRANE databases. The following research question was delimited: "What are the strategies and interventions used for eye care in the management of critical patients or surgical patients submitted to the prone position?" The sample consisted of 24 studies after applying the inclusion and exclusion criteria. Results: Eye care interventions in managing critical/surgical patients submitted to the prone position were eye examination, use of lubricants/specific ophthalmic solution, reverse Trendelenburg positioning, and protection with adhesive tape. Conclusions: This review allowed the understanding of eye care for critical/surgical patients in a prone position. Among the care presented, a large part is related to nursing since it is closer to patient care. The findings emphasize the need to implement patient safety policies with eye care as a priority. [ABSTRACT FROM AUTHOR]

Preventive eye care is a preferred practice that includes recommended regular eye examinations, which is not always followed. This study examined attitudes of ophthalmologists toward routine eye examinations, analyzed compliance with their own eye examinations, and described reasons for non-compliance. This was a cross-sectional study involving an online survey, sent to all members of the Israeli Ophthalmological Society (IOS) asking their personal opinions concerning routine eye care, self-performance of these tests, and reasons for non-compliance. A total of 243 responses were received (59% males, mean age 52 years) representing 40% of IOS members. 98% of respondents think that adults should be routinely screened for eye diseases, most commonly annually (52%) or every two years (36%); however, only 55% of ophthalmologists reported having themselves a routine eye check in the past 3 years, which is significantly lower than their spouse (68%, P = 0.003). Recommendations for routine eye examinations were always higher than their actual performance regardless of the responding ophthalmologists' gender, age or country of birth. Furthermore, female gender was found to be a negative predictor of having these examinations. Pupil dilation was performed in 38% of ophthalmologists' testing, even though 80% of them think it is necessary for a complete examination. 'Lack of time' (35%) and 'forgetfulness' (31%) were the main reasons provided by ophthalmologists as an explanation for not having regular eye testing. Ophthalmologists typically recognize the importance of preventive eye care, recommending periodic eye examinations for their patients; however, self-performance of these evaluations by the ophthalmologists themselves is much lower. [ABSTRACT FROM AUTHOR]

Hearing loss (HL) affects over 20% of the global population, and a high proportion of adults visiting eye care services may have underlying deficits in their hearing ability. It is important that vision professionals understand HL so they get the best from the eye exam and ensure implementation of appropriate support, as strategies for supporting low vision may not be effective if the patient also has underlying HL. The aim of this paper is to introduce HL and suggest practical tips for assessing and managing eye care in people with varying degrees of HL. [ABSTRACT FROM AUTHOR]

CONTEXT: The increased prevalence of nonstrabismic binocular vision anomalies (NSBVA) has given rise to the need for cost-effective screening and diagnostic tools. AIMS: The aim of the study is to assess the efficacy of an indigenously developed computer-based binocular vision assessment software (Train Your Eyes®) in screening NSBVA. SUBJECTS AND METHODS: Subjects who visited the binocular vision clinic of a tertiary eye care center with asthenopic symptoms between January 2019 and January 2020 were included in the study. Patients with other ocular comorbidities and stereopsis poorer than 500 arc seconds were excluded. All subjects underwent a comprehensive eye examination followed by binocular vision assessment using both the manual and computer-based methods. STATISTICAL ANALYSIS USED: Receiver operating characteristic (ROC) curves were utilized to choose the cut-off points that maximize the sensitivity and specificity. RESULTS: The mean (standard deviation) age of 88 subjects was 22 (4.5) years with 34 males. Based on the conventional manual assessment, 71 (81%) were diagnosed to have NSBVA and 17 (19%) had normal binocular vision. Based on the ROC analysis, the following cut-off points are proposed: 14 prism diopter (PD) for near positive fusional vergence amplitudes, 4.5 PD for near negative fusional vergence amplitudes, 4.5 cycles per minute (cpm) for binocular accommodative facility, and 3.5 cpm for monocular accommodative facility. All the binocular vision parameters demonstrated statistical significance in the ROC analysis (P < 0.05). CONCLUSIONS: The software-based screening tool was found to be highly sensitive in identifying NSBVA and thus could be used as a potential screening tool in the clinic and community. [ABSTRACT FROM AUTHOR]

Communication is an essential part of a successful eye care consultation. Effective interactions between practitioner and patient can optimise the outcomes of clinical activities as well as levels of patient satisfaction and comfort. In this article we draw on the results of our own research studies to identify some key communication issues in eye care consultations. We highlight the importance of understanding the consultation from the patient perspective and discuss how this understanding can help optometrists recognise patient communication behaviours that can otherwise appear puzzling. In particular, we focus on: patient difficulties answering opening questions; patients talking at length; patient displays of concern to do well in tests; and patient difficulty understanding and following treatment advice. [ABSTRACT FROM AUTHOR]

Vision loss and blindness are among the top ten disabilities in the United States, yet access and utilization of eye care remains low. Vision Detroit aimed to address eye-care disparities via community-based screenings. By investigating burden of eye disease and barriers to eye-care utilization in an underserved urban community, we may direct efforts to improve access. Twenty-three screenings were conducted from March 2015-November 2017. Patient information gathered at screenings were demographics, medical and social history, eye exam/referral history, insurance status, primary care physician (PCP) status, and patient-perceived eye-care barriers. Three-hundred-eighty patients were screened, 42% African American and 51% Hispanic. Average age was 53 ± 16.4 years, 70% reported vision problems, 50% reported over two years of vision problems, and average habitual visual acuity in best-seeing eye was 20/37. Eye-care underutilization was reported in 61% of type-2 diabetics. Older age and PCP recommendations/referrals were associated with increased utilization in all patients. Insurance was the most common barrier (53%); of the 55% insured, 31% reported financial barriers. Employed patients were more likely than unemployed to report a time barrier (odds ratio = 1.76, 95% confidence interval 1.03–3.01). Those with high school or less education reported "unaware of need", "unsure where to go", "transportation", and "insurance" as barriers more often. Visual burden was pervasive, yet access was suboptimal. Financial, logistical, and awareness barriers were common. PCP referral and older age were associated with increased utilization. Those less educated reported more barriers, highlighting the need to address fiscal concerns and eye-health education. [ABSTRACT FROM AUTHOR]

Background: Uncorrected refractive error (URE) is a major cause of vision impairment in children worldwide. Cases are often detected through a school-based vision screening program and then treated in a follow-up appointment. This requires parents or guardians ('parents') to adhere to referrals for the eye exam and care plan. We aim to understand the reasons for parents' referral non-adherence in Cross River State, Nigeria, using qualitative methods. Methods: Ten focus groups were held with parents who had not adhered to the referral for a follow-up eye examination. Participants were recruited with help from staff in schools hosting the vision screening programme. Interviews were conducted using a semi-structured interview guide, audio taped and transcribed verbatim. After identifying relevant quotes, the researchers labelled each one with a descriptive code/subcode label. Then they clustered the data into categories and overarching themes. Results: Forty-four parents participated in 10 focus group discussions with 28 women and 16 men. Three themes and participated in the focus group discussions with 28 women (63%). Twelve themes were generated. The three megathemes were Modifiable Factors (with 4 themes), Contextual Factors (with 6 themes), and Recommendations (with 2 themes). Conclusion: Participants identified modifiable barriers that make it difficult for parents to adhere to a referral for a follow-up eye exam. These include not believing their child has a vision problem or the screening test, and issues with the referral letter. They also described important contextual factors such as poverty, logistical problems, parental attitudes towards their children and beliefs about appropriate care. Many of these issues could be addressed by following their recommendation to educate the public on the importance of child eye care and correct parents' misconceptions. These themes will be used by the Nigerian government to enhance and scale up its child eye health programme. [ABSTRACT FROM AUTHOR]

Purpose/Aim: In the United States, high rates of vision impairment and eye disease disproportionately impact those who lack access to eye care, specifically vulnerable populations. The objective of our study was to test instruments, implement protocols, and collect preliminary data for a larger 5-year study, which aims to improve detection of eye diseases and follow-up eye care in vulnerable populations using community health workers (CHW) and patient navigators. In the study, trained CHWs conducted vision screening and patient navigators scheduled on-site eye exams and arranged appointments for those referred to ophthalmology to improve adherence to follow-up eye care. Materials and Methods: Eligible individuals age 40-and-older were recruited from the Riverstone Senior Center in Upper Manhattan, New York City. Participants underwent on-site vision screening (visual acuity with correction, intraocular pressure measurements, and fundus photography). Individuals who failed the vision screening were scheduled with an on-site optometrist for an eye exam; those with ocular pathologies were referred to an ophthalmologist. Participants were also administered the National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ-8) and Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test by community health workers. Results:Participants (n = 42) were predominantly older adults, with a mean age of 70.0 ± 9.8, female (61.9%), and Hispanic (78.6%). Most individuals (78.6%, n = 33) failed vision screening. Of those who failed, 84.8% (n = 28) attended the on-site eye exam with the optometrist. Ocular diagnoses: refractive error 13/28 (46.4%), glaucoma/glaucoma suspect 9/28 (32.1%), cataract 7/28 (25.0%), retina abnormalities 6/28 (21.4%); 13 people required eyeglasses. Conclusion: This study demonstrates the feasibility of using CHWs and patient navigators for reducing barriers to vision screening and optometrist-based eye exams in vulnerable populations, ultimately improving early detection of eye disease and linking individuals to additional eye care appointments. The full five-year study aims to further examine these outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Good vision during childhood is vital for visual, educational, and social development. Previous research highlights challenges in the accessibility of eye care for children. This study investigates the accessibility of primary eye care for young children with typical development and those with autism in England. Methods: A telephone survey was conducted using four hypothetical scenarios (a child aged 1, 3, 5 years and a 13‐year‐old with autism). Four hundred community optometric practices (100 different practices for each scenario) were contacted to explore the availability of an eye examination. The caller acted as a parent, asking about the availability of an eye examination for their child and raising concerns regarding the child. Key barriers and enablers to the accessibility of primary eye care were identified through an analysis of qualitative information. Results: Of the 400 practices, only three (<1%) stated that they do not perform eye examinations on children. Fifty‐six practices (14%) stated that they would examine a child at any age, the remainder (n = 341, 85%) specifying a minimum age at which they would perform eye examinations on children. Lack of 'communication' from the child and 'equipment' were identified as barriers to accessing eye care for young children. Eye care for children with autism was enabled by factors related to adaptability and appointment time. Conclusion: Our results suggest that communication and a lack of appropriate equipment for examining children are potential barriers to accessing primary eye care. No clear barriers were identified for an older child with autism. Eye examinations are more accessible for older children in these scenarios (aged 5 with typical development and 13 years with autism) than younger children (aged 1 and 3 years old). While the UK General Ophthalmic Services (GOS) terms do not permit contract holders to exclude categories of patients from a GOS eye exam, our findings suggest this is taking place. [ABSTRACT FROM AUTHOR]

Background: Cataract is the major cause of reversible blindness and visual impairment in developing countries. It has been assumed that there is poor access to information related to the cause, prevention, and treatment of cataract in developing countries. There is also a paucity of data on knowledge and attitude towards cataract in Ethiopia. Purpose: This study aimed to assess the knowledge and attitude of cataract and their associated factors among adults in Arba Minch Zuria Woreda, Southern Ethiopia. Patients and Methods: A community-based cross-sectional study was conducted among 623 adults from February 6 to April 16, 2020. The study participants were selected by the multi-stage sampling technique. Data were collected with a pre-tested structured questionnaire by using face-to-face interviews. The data were entered into Epi info version 7.2 and exported to SPSS version 23 for analysis. The level of statistical significance was set at a p-value less than 0.05 in multivariable logistic regression. Results: Among 623 total participants, 54.9% of them had good knowledge about cataract, while 37.9% of them had favorable attitude about cataract. Inability to read and write (AOR=0.104, 95% CI: 0.042– 0.258), primary school educational level (AOR=0.208, 95% CI: 0.091– 0.478), secondary school educational level (AOR=0.199, 95% CI: 0.088– 0.451), earning average monthly income 350– 820 Ethiopian birr (AOR=2.364, 95% CI: 1.277– 4.373), not having previous eye examination (AOR=0.605, 95% CI: 0.425– 0.861) and unavailability of eye clinic (AOR=0.65, 95% CI: 0.446– 0.945) were significantly associated with knowledge of cataract. No history of cataract (AOR=0.257, 95% CI: 0.157– 0.418) was significantly associated with attitude towards cataract. Conclusion: Significant portion of participants had poor knowledge and an unfavorable attitude towards a cataract. So, it is recommended that stakeholders in different hierarchies need to exert efforts on creating awareness about cataract by considering the education level of the community. Moreover, attention should be given to the availability and accessibility of the primary eye care unit. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to create vision standards for various tasks performed by hairdressers and to assess the spectacle compliance and its impact at work.Methods: The observational cross-sectional study enrolled hairdressers in and around Chennai, Tamil Nadu. It was done in three phases: (i) Job profiling from visual task analysis, creating vision standards for various hairdressing tasks and arriving at test protocols; (ii) Comprehensive eye examination, and (iii) Assessment of spectacle compliance and its impact on work. Descriptive analysis using Microsoft Excel and SPSS (IBM SPSS Statistics Version 21.0) was performed.Results: There were 305 participants with a mean age of 48 (SD ± 12) years. The visual acuity demand was found to be 6/18 and N15, for distance and near, respectively. Appropriate spectacles were prescribed for 203 (67%) hairdressers. Even with the best possible refractive correction, a few hairdressers did not meet the distance (13) and near (11) visual acuity standard. In all, 54 hairdressers were referred for further examination to a tertiary eye care center for lenticular changes, retinal abnormalities, and glaucoma screening. Among the subjects who were dispensed with spectacles, 181 (86%) were available for telephonic spectacle compliance assessment, and 164 (90%) were compliant with spectacle usage at work. Improved visual ability was reported by 133 (81%) hairdressers at work.Conclusion: This study provides vision standards for hairdressers. From the visual task analysis, hairdressing tasks were found to be visually demanding and hazardous. The study emphasizes that providing appropriate spectacle correction showed a clinically evident positive impact at work. [ABSTRACT FROM AUTHOR]

BACKGROUND: Rural population is highly underprivileged in terms of access to tertiary eye care facilities. AIMS: The aim of the study was to determine the prevalence of diabetic retinopathy (DR) and associated risk factors among known diabetics in the rural population of Belgaum district. SETTINGS AND DESIGN: A cross-sectional population-based study was carried out from January 2018 to December 2018. METHODOLOGY: Three hundred and forty patients underwent a detailed ocular examination. Clinical grading was based on early treatment of DR study guidelines. Random blood sugar, blood pressure, height, weight, hemoglobin, serum creatinine, and glycated hemoglobin (HbA1c) were measured. STATISTICAL ANALYSIS: Chi-square and analysis of variance tests were used to assess risk factors. RESULTS: The prevalence of DR was found to be 23.82%. Of this, 19.11% had nonproliferative DR (PDR) and 3.53% had PDR. Nearly 1.18% had clinically significant macular edema. A statistically significant association was found between DR and duration of diabetes, HbA1c, smoking, and family history of diabetes. CONCLUSION: The significant prevalence of DR as per this study signifies the need for regular structured screening camps and the availability of basic vitreoretinal facilities at the primary level. [ABSTRACT FROM AUTHOR]

The National Eye Institute was established by Congress in 1968 to support projects that research ways to prevent, treat, or reverse vision loss. The National Eye Institute is on the front lines of vision research and provides consumer health information to the public to educate users on vision problems and how to keep their eyes healthy. [ABSTRACT FROM AUTHOR]

PURPOSE: This study aims to assess knowledge, attitude, and practice (KAP) around diabetic eye disease in patients with diabetes mellitus (DM) attending primary health-care centers (PHCCs) in Jazan region, Saudi Arabia. METHODS: All diabetic patients attending eight PHCCs in Jazan region between December 2018 and December 2019 were invited to participate in this cross-sectional study. Face-to-face interviews were held to gather responses to a validated 20-item questionnaire. RESULTS: In total, 293 patients aged 9–90 years (mean 50 years, standard deviation 14 years) agreed to participate, including 189 (64.5%) females and 104 (35.5%) males. Most (n = 251; 85.7%) had type 2 DM, the remainder (42; 14.3%) having type 1 DM. The mean duration of DM was 8.2 ± 6.4 years. Eye complications were self-reported by 114 (38.9%) participants. More than one-third (36.2%) of the participants had never undergone an eye examination. Less than one-third of participants (29% and 28% respectively) had an excellent level of knowledge or practice about diabetic eye disease, and only 12% demonstrated very positive attitude. KAP levels were independently predicted by patients' age, gender, and eye complication status. CONCLUSION: KAP relating to eye disease and eye care among Saudi patients with DM were less than desired. Rigorous efforts are required to raise awareness of eye complications among diabetic patients. [ABSTRACT FROM AUTHOR]

Background:Teleretinal imaging has been demonstrated to increase diabetic patient compliance with annual retinal examinations, but few studies have examined patient behavior after screening. Compliance with eye specialist follow-up is critical to ensure remote detection programs improve long-term vision outcomes for patients with diabetes. Introduction:The purpose of this study was to assess the rate of eye specialist follow-up compliance after referral for diabetic retinopathy (DR) from a teleretinal imaging program in a large primary care group practice. Materials and Methods:This is a retrospective chart review study of patients examined through a teleretinal imaging program between June 2015 and October 2017. Data from an electronic medical record were used to determine whether patients who were referred for management of DR requiring treatment attended follow-up eye care appointments. Reasons for nonattendance were also identified. Results:During the study time period, there were 110 patients referred for detected vision-threatening DR. Of those patients, 62 (56.3%) had an eye examination within 3 months, 83 (75.5%) had an examination within 1 year, and 92 (83.6%) had an examination within the 30-month study period. Of the patients who had follow-up eye examinations, 62.7% confirmed the diagnosis of vision-threatening DR and 89.2% had some level of DR. Discussion:Teleretinal imaging programs not only increase patient compliance with diabetic retinal examinations but can also generate accurate referrals and yield high rates of compliance with follow-up. Conclusions:These findings suggest that evaluating patients for DR in the primary care setting is an effective method of detecting vision-threatening retinopathy. However, assuring patient follow-up and treatment for vision-threatening DR detected in primary care telemedical networks remains a challenge. [ABSTRACT FROM AUTHOR]

Background: Optometrists with different levels of optometric education in India provide eye care services under various capacities to the public. Aim: The study evaluated the status of optometrists in terms of their knowledge, skills and frequency of skill utilisation in public and private sectors. Setting: A quantitative study design was adopted using a survey questionnaire that was distributed to optometrists providing eye care services in public and private sectors. Methods: A structured and validated questionnaire with closed-ended questions was administered to 650 participants. Results: A total of 400 completed questionnaires were received (response rate = 62%) of which 207 respondents were males (52%) and 193 females (48%). Most (57%) of the respondents were bachelor's degree holders with 86% of the respondents in the private sector and 14% in the public sector. The knowledge level of ancillary and diagnostic tests (69%) was the least amongst public sector optometrists whilst it was binocular indirect ophthalmoscopy (66%) for private sector optometrists. The skill levels in indirect ophthalmoscopy was least amongst the public sector (56%) and private sector (44%) optometrists. Indirect ophthalmoscopy showed the least frequency of skill utilisation amongst public sector (13%) and private sector (34%) optometrists. Conclusion: The study highlighted the need for mandating best practice standards, and expanding the scope of defined practice, as optometrists are better suited for diagnostic roles and comprehensive eye examinations, and can contribute effectively towards averting preventable blindness. [ABSTRACT FROM AUTHOR]

Background: Visual impairment is disproportionately distributed between rural and urban dwellers. Rural dwellers have limited access to the eye care services that are available in urban cities. Aim: The aim of this study was to determine the prevalence and causes of visual impairment in Dariyah, a rural community in the Qassim region, Saudi Arabia. Setting: This research comprised a population-based assessment of the vision and visual status of the inhabitants of Dariyah community. Methods: A cross-sectional descriptive study was conducted amongst the inhabitants of the community of Dariyah. A comprehensive eye examination consisting of visual acuity, ocular health examination, objective and subjective refraction was performed. The examinations were conducted by registered ophthalmologists and optometrists from the Qassim University. Vision impairments were categorised according to the International Classification of Diseases (ICD), Section 9D90, 'Vision impairment including blindness' (2018). Results: In all, 68 (24.5%) participants had vision impairment (using the better-seeing eye), with refractive errors being the main cause of vision impairment. Other causes of vision impairment included cataract (20, 7.2%), trichiasis (5, 1.8%) and glaucoma (2, 0.7%). Refractive errors were present in 193 (69.7%), with astigmatism being the commonest refractive error. About 60% of those with refractive errors presented without spectacles for correction, and 20% reported that they had never had an eye examination. Refractive errors could not be determined in 19 (6.9%) of the subjects because of conditions such as matured cataract and other ocular abnormalities. Conclusion: Uncorrected refractive error was found to be the leading cause of vision impairment in this rural community in Saudi Arabia. [ABSTRACT FROM AUTHOR]

To evaluate the effect of a mobile-based screening programme on eye care utilization in Iran. In this cluster randomized community trial, a representative sample of residents aged≥50 years from urban and rural areas in four districts in Tehran province were enrolled. The clusters were randomly assigned to one of the three parallel arms; the mHealth arm with digital data collection, vision screening test and retina evaluation using an integrated mobile application, the conventional arm with manual data collection and screening tests using Snellen chart and Fundus photography at the local primary healthcare facility, and the control arm with manual data collection without screening tests. The main outcome measure was eye care utilization which was defined as at least one visit to an optometrist or ophthalmologist. Of 3312 eligible individuals, 2520 (76.1%) participated. In the first 3 months after the screening programme, eye care utilization was higher among those who were referred by the mHealth method (35.6% 95%CI: 31.1–40.4%) compared to those referred by the conventional method (32.7%, 95%CI: 27.5–38.2%) and to those observed in the control arm (4.5%, 95%CI: 3.2–6.0). Eye care utilization improved (OR = 1.5, 95%CI: 1.2–1.9) among the referred people after the screening programme compared to the utilization before this programme; however, this improvement was significantly higher in the mHealth method (OR: 1.7, 95%CI: 1.2–2.4) compared to the conventional method (OR: 1.2, 95%CI: 0.8–1.8). The mobile-based screening programme can significantly improve eye care utilization at the community level. [ABSTRACT FROM AUTHOR]

Importance Screening for diabetic retinopathy for early detection and treatment can prevent vision loss. Background: We aimed to assess rates of eye examination of people with diabetes, adherence with national guidelines and investigate characteristics of those who do not adhere. Design We used data from the 45 and Up Study, a cohort study of 267 153 randomly selected residents aged ≥45 years from New South Wales, Australia. Individual survey data collected in 2006 to 2009 were linked to corresponding national Medicare Benefits Schedule claims data for 2006 to 2016. Participants: The study sample included 24 832 participants who reported having diabetes and at least 5 years of observation. Methods: Claims for visits to optometrists or ophthalmologists were assessed to estimate rates of eye examination. Poisson regression models were used to investigate factors associated with non‐adherence. Main outcome measure: Participants were classified as adherent if the average time between eye care claims was consistent with national guideline of having an eye exam every 2 years. Results: Of 50% to 75% people with diabetes met the biennial eye examination guidelines and only 21% to 28% with diabetes duration ≥10 years were adherent to the annual eye examination guideline. Characteristics associated with greatest (~1.3‐fold) risk of non‐adherence were smoking, age <60 years and higher income. Conclusions and relevance: There is a clear need to improve rates of adherence to eye examination guidelines among people with diabetes to reduce the personal and societal burden of diabetic retinopathy. [ABSTRACT FROM AUTHOR]

Background: Visual problems can negatively affect visual development and learning but often go undetected. We assessed the feasibility of scaling up a school-based screening program to identify and treat kindergarten children with visual problems.Methods: We conducted a prospective cohort study offering vision screening to junior (JK) and senior kindergarten (SK) children attending 43 schools in 15 Ontario communities. Screening comprised photoscreeners and tests of visual acuity, stereoacuity and eye alignment. Children who failed any test were referred for a comprehensive eye examination, with treatment as needed (e.g., glasses).Results: Using a passive consent model, 89% of children were screened compared with 62% using an active consent model (p < 0.001). Referral rates to an optometrist varied across schools (mean referral rate for children in JK 53%, range 25%-83%; mean referral rate for children in SK 34%, range 12%-61%). Among 4811 children who were screened, a visual problem was detected in 516 (10.7%), including 164 (3.4%) with amblyopia and 324 (6.7%) with clinically significant refractive errors. For 347 (67.2%) of the children with a visual problem, this was their first eye examination. Rescreening in Year 2 did not lead to detection of additional problems among children who passed screening in Year 1. Regardless of location (child's school or optometrist's office), 1563 (68.9%) of children attended the follow-up optometry examination. Most of the children who were surveyed (291 of 322, 90.4%) indicated that they enjoyed vision screening.Interpretation: Many children in Ontario with a visual problem were not being identified by the status quo in 2015-2017. We found that in-school vision screening with follow-up eye examinations is an effective strategy for identifying at-risk children and placing them in eye care before grade 1. [ABSTRACT FROM AUTHOR]

Purpose: To describe the use of eye care services among adults treated for diabetes from 2008 to 2017 in the French population. Methods: We used a random representative sampling of the French national health insurance database. Participants were adults treated for diabetes. Data regarding visits to ophthalmologists, eye examination procedures, and medical treatments were extracted using reimbursement codes. Cross-sectional analyses of eye care claims were performed each year from 2008 to 2017. Results: Less than 50% of people with diabetes underwent an annual eye examination (2008: 44.7%; 2017: 47.9%), and less than two-thirds underwent a biennial eye examination (2008-2009: 62.6%; 2016-2017: 66.4%). From 2008 to 2017, the yearly use of optical coherence tomography examinations increased steadily and markedly from 2.7% to 16.2%, while the use of fluorescein and indocyanine green angiographies decreased from 2.4% to 0.9%. In the same period, the yearly rate of intravitreal injection increased from 0.3% to 1.5%, and the use of laser photocoagulation decreased progressively from 2008 to 2014 (1.3% vs. 0.7%) but slightly increased from 2015 to 2017 (0.8% vs. 1.0%). Conclusions: Strategies to increase compliance with eye care recommendations are needed to improve early detection and management of diabetic eye complications. [ABSTRACT FROM AUTHOR]

Purpose: To examine factors decreasing participation in school-based vision programs from parent and teacher perspectives. Methods: We conducted 41 semi-structured focus groups (20 parent groups, 21 teacher/staff groups), at 10 Baltimore and 11 Chicago public elementary and middle schools offering school-based vision programs. School-based vision programs provided vision screening, eye exams, and eyeglasses if needed. Focus groups ranged in size from 2–9 participants (median = 5). Sessions were recorded, transcribed, and coded through an iterative process to develop themes using inductive analysis. Results: Ninety parents and 117 teachers/staff participated. Participants identified five major factors decreasing participation in school-based vision programs: (1) challenges with the consent form, including distribution, collection, and literacy and language barriers; (2) having existing eye care; (3) misunderstandings about the program, especially related to cost and insurance; (4) difficulty raising parental awareness of the program; and (5) certain attitudes towards vision, eye care, and school-based programs, including low prioritization of eye care, mistrust of the program, fear of sharing private information, not believing their child needs glasses, and reluctance accepting 'subsidized' services. Conclusion: Parents and teachers identified important structural barriers to participation (i.e., consent form challenges and low parental awareness) and specific reasons for non-participation (i.e., attitudes, misunderstanding of the program, existing eye care) in school-based vision programs. Effective strategies are needed to facilitate return of consent forms and promote awareness of school-based vision programs among parents. Programs should also target services towards those currently without access to eye care and increase awareness about paediatric vision needs. [ABSTRACT FROM AUTHOR]

Ophthalmologic telemedicine programs help to address the growing demand for eye care and lessen healthcare disparities for patients. One example is Technology-Based Eye Care Services (TECS), implemented in the Veteran Affairs Healthcare System in 2015. Accuracy and quality data for TECS both have been reported, and data suggest that although the TECS examination is comparable with an in-person examination, sensitivity for glaucoma and glaucoma suspect detection is less than that for other diseases, such as macular degeneration. Several articles suggest that OCT can improve disease detection for glaucoma. Therefore, this study was undertaken to test the impact of OCT on the accuracy of the TECS protocol. This article reports the data from part II of the TECS Compare trial; results from part I are discussed in a previous article. Prospective comparison between the TECS protocol with OCT versus a face-to-face (FTF) examination for 256 patients. An eligible patient was defined as a patient with no known ocular disease who desired a routine eye examination. Patient underwent the TECS protocol workup and OCT nerve, OCT macula, and FTF examination on the same day. Percent agreement, κ values, sensitivity, and specificity were calculated for nonexpert readers after OCT interpretation of the TECS protocol using the FTF examination as the clinical gold standard. OCT did not improve the diagnostic accuracy of the TECS protocol when compared with an FTF examination. In most cases, OCT had no impact, and in the case of reader 2, OCT actually reduced the κ value from moderate agreement to agreement equal to chance while lowering the percent agreement by 10%. OCT also did not impact inter- or intrareader variability parameters. In this study, OCT did not seem to improve the accuracy of glaucoma or retinal disease detection when added to the standard TECS protocol. In one case, OCT worsened the agreement of the reader compared with the FTF. Further study is necessary to confirm these findings, and results may change if the readers are glaucoma or retina specialists instead of nonexpert OCT readers, comprehensive and anterior segment specialists. [ABSTRACT FROM AUTHOR]

Purpose: To see the effect of binocular vision problems on childhood academic performance and to record the teacher's perspectives about childhood eye care in Khartoum State of Sudan. Place and Duration of Study: A descriptive cross-sectional study done among the school going children in the Khartoum State of Sudan from February to May, 2018. Study Design: Descriptive cross sectional study. Material and Methods: Three hundred and forty (340) primary school children were recruited for study by convenient sampling technique during the academic year 2018. After relevant history, ocular examination was performed. It included visual acuity measurement, assessment of refractive errors and binocular function tests. Academic performance of the children was recorded from academic records of the children. Finally, the qualitative data was derived from teachers' perspectives about childhood eye care. Results: Mean age of the participants was 11.96 ± 1.63 years. The findings revealed that (78.6%) of children achieved poor academic performances with decompensated exophoria at near. 52.7% children with poor academic performances had weak positive fusion reserve at near P = 0.04. 37.2% of the poor performers had convergence insufficiency. Forty-eight percent of females with ocular complaints achieved poor academic performances P = 0.034. With regard to teacher's perspectives about childhood eye care, 98.8%believed that the vision problems had effect on the academic record of the children. Seventy percent of the teachers reported that the students did not undergo eye examinations before joining school. Conclusion: Convergence Insufficiency and weak positive fusional reserve at near has a significant effect on academic performances. [ABSTRACT FROM AUTHOR]

Background: There is a growing awareness that addressing chronic as well as acute health conditions may contribute importantly to the well-being of displaced populations, but eye care service has generally not been prioritized in crisis situations. We describe a replicable model of eye care provision as delivered by Orbis International and local partners to the Rohingya and host population in Cox's Bazar, Bangladesh, and characterize the burden of vision impairment and demand for sight-restoring services in this setting.Methods and Findings: Orbis International and local secondary facility Cox's Bazar Baitush Sharaf Hospital (CBBSH) provide eye care support to the Rohingya population and the host community of all ages in Cox's Bazar, Bangladesh, with fixed vision screening locations established in Camps 4 and 11 of the Kutupalong refugee settlement. Structured outreach targets these camps and four surrounding local subdistricts, with referrals made as needed for refraction (glasses measurement) and cataract surgery to CBBSH. Between February 2018 and March 2019, 48,105 displaced Rohingya (70.3%, among whom 71.6% were children and 46.5% women) and 20,357 local residents (29.7%, 88.5% children, 54.4% women) underwent vision screening. Displaced Rohingya sought services from a total of 12 surrounding camps, within which coverage was 17.3%, including 43.3% (27,027/62,424) of children aged 5-11 years and 60.0% (5,315/8,857) of adults ≥ 60 years old. The prevalence of blindness (presenting acuity < 3/60) among Rohingya patients exceeded that among local residents by 3- to 6-fold in each 10-year age group between 18 and 59 years (P < 0.001 comparing vision between the two groups in this age range), and the prevalence of cataract requiring surgery was also higher in Rohingya patients (18-29 years: 4.67% versus 1.80%, P = 0.0019; 30-39: 7.61% versus 2.39%, P < 0.001; and 40-49 years: 7.91% versus 3.77%, P = 0.0014). A limitation of the study is lack of data on population prevalence of eye disease.Conclusions: The burden of untreated eye disease is very high among the Rohingya, particularly those in their peak working years who could contribute most to the resiliency of their community. Demand for eye care service is also great among children and adults in this population with many competing healthcare priorities. Research is needed, building on strong evidence of benefit in settled populations, to explore the specific impact of vision care on the well-being of displaced populations. [ABSTRACT FROM AUTHOR]

Background: Motivators and deterrents for seeking eye care in a Canadian setting were sought using a qualitative study. Provincial deregulation of eyewear dispensing in 2010 allows consumers to order eyewear without an optical prescription, thus eliminating a potential motivator for obtaining an eye examination.Methods: Convenience sampling was used to obtain 25 members of the public who contributed to one of seven focus groups that were facilitated, audiotaped, anonymised and transcribed. Participants completed a demographic questionnaire. Focus group data analysis employed grounded theory and theme saturation determined the number of focus groups.Results: Nine men and 16 women participated, ranging in age from 18 to 71 years (mean 41.5; median 40.0). Three main themes were identified as influencers for seeking eye care: priority; advice; and capacity. Priority served as a motivator ('lived experience', 'symptoms', and 'habit') and deterrent ('test distress', 'asymptomatic', 'don't know' and 'other priorities'). Advice was a motivator ('professional' and 'family/friends'), while capacity was a motivator ('insurance') and deterrent ('cost').Conclusion: The motivators and deterrents of seeking eye care in these focus groups were framed by three themes. Key findings not reported previously included the motivators of 'habit', 'advice' and 'insurance' and the potential deterrent of 'test distress'. These factors should be added to other previously reported motivators and deterrents in further exploration of Canadian eye-care seeking behaviours. Such knowledge is needed to develop strategies for improving eye-care literacy in Canada. This is particularly important because eyewear deregulation and/or online eye examinations may encourage members of the public to bypass comprehensive eye care without fully understanding the implications of this decision for their health and wellness. [ABSTRACT FROM AUTHOR]

Background: Currently, no specific collaborative care pathway exists that distinguishes open angle glaucoma from narrow angle or angle closure disease. This study evaluates a newly developed referral and collaborative care pathway specifically for patients with angle closure spectrum disease.Methods: The medical records of consecutive patients referred to the Centre for Eye Health for glaucoma assessment were examined, six months before (Pre Suite) and after (Post Suite) the introduction of a novel referral pathway for anterior chamber angle assessment (Angle Suite). Patient demographic and clinical data, the referral letter and practitioner characteristics were extracted.Results: Angle Suite (n = 77) patients had an appointment much sooner compared to Pre (n = 383) and Post Suite (n = 425) patients (p < 0.0001). Following the introduction of Angle Suites, there was a reduction of incidental angle closure disease found in routine, non-angle closure glaucoma assessment. Onward referral was required by 36.4 per cent of patients referred for suspected angle closure disease, while the rest could be discharged back into the community (13.0 per cent) or reviewed at the Centre for Eye Health (50.6 per cent). Multinomial logistic regression found that the presence of an angle description in the referral letter improved the true positive rate for angle closure disease (p < 0.0001).Conclusions: The clinical pathway may reduce the number of incidental angle closure patients and improved the timeliness of appropriate clinical care delivered to a subset of patients who may benefit from prompt medical attention. This pathway provides an opportunity for appropriately staffed and equipped collaborative care clinics to reduce the burden on tertiary level ophthalmic facilities. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the accuracy of Spot photoscreener (PS) as a noncycloplegic photorefractor in detecting amblyopia risk factors (ARFs) in preschool children in an Indian eye clinic setting. Also, to derive appropriate cutoff values for screening to obtain maximum sensitivity and specificity of the device in detecting ARF.Methods: This was a cross-sectional study conducted in the outpatient pediatric eye clinic at a tertiary eye care institute. A Spot PS was used to screen all the children between the ages of 6 months and 5 years that presented to the eye clinic from August 2018 to October 2018. This screening was followed by a complete eye examination, including cycloplegic refraction by a masked examiner. The 2013 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines were considered the standard cutoff values for clinically significant refractive error in children younger than 5 years of age.Results: The study comprised of 219 children. The Spot PS diagnosed 135 (61.64%) children with ARF as compared with 124 (56.62%) children detected by clinic examination. For ARF detection, the Spot photoscreeneer had 85.48% sensitivity, 69.47% specificity, 78.52% positive predictive value and 78.57% negative predictive value. The sensitivity for detection of strabismus and hypermetropia was very low (42% and 36%, respectively). The 95% limits of agreement ranged from -5.48 to +5.59 diopters (D) with a bias of 0.06 D for spherical equivalent between noncycloplegic photorefraction and cycloplegic refraction.Conclusion: The Spot PS may be used as a screening tool to detect ARF in children younger than 5 years of age keeping its limitations in consideration. However, the performance can be improved by modifying the cutoff values for the referral. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of present study was to investigate eye care behaviors based on the BASNEF model and Health Locus of Control (HLOC) in patients with type 2 diabetes(T2D). Methods: This cross-sectional analytical study was carried out on 150 patients with T2D in Iran in 2019. The subjects were selected using simple random sampling. The data collection tools included demographic, eye self-care behavior inventory based on BASNEF model and health locus of control whose validity and reliability were confirmed. Data analysis was carried out using Independent samples-t test ANOVA, and linear regression in SPSS ver. 24. Result: The results of linear regression showed that knowledge, attitude, subjective norms, enabling factors, internal HLOC, chance HLOC and external HLOC were able to predict 17% of intention to eye self-care behaviors (P < 0.001) and attitude was the strongest construct in predicting intention of eye care behavior in patients with T2D (P < 0.05). In this study, most people had internal HLOC and mean (± SD) of their internal construct was 27.42(± 2.73). Also, the enabling factors construct showed a significant correlation with the internal HLOC (r = 0.283) and behavioral intention (r = 0.348) (P < 0.001). Conclusion: The results of this study showed that attitude and enabling factors are effective constructs in predicting the intention to perform preventive behaviors of ocular complications in T2D patients. Therefore, it is recommended to organize training classes, access resources, and educational information, facilitate access to physicians for eye examinations, create new skills for care and prevention of ocular complications. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the sensitivity and specificity of smartphone-based nonmydriatic (NM) retinal camera in the detection of diabetic retinopathy (DR) and sight-threatening DR (STDR) in a tertiary eye care facility.Methods: Patients with diabetes underwent retinal photography with a smartphone-based NM fundus camera before mydriasis and standard 7-field fundus photography with a desktop mydriatic fundus camera after mydriasis. DR was graded using the international clinical classification of diabetic retinopathy system by two retinal expert ophthalmologists masked to each other and to the patient's identity. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to detect DR and STDR by NM retinal imaging were assessed.Results: 245 people had gradable images in one or both eyes. DR and STDR were detected in 45.3% and 24.5%, respectively using NM camera, and in 57.6% and 28.6%, respectively using mydriatic camera. The sensitivity and specificity to detect any DR by NM camera was 75.2% (95% confidence interval (CI) 68.1-82.3) and 95.2% (95%CI 91.1-99.3). For STDR the values were 82.9% (95% CI 74.0-91.7) and 98.9% (95% CI 97.3-100), respectively. The PPV to detect any DR was 95.5% (95% CI 89.8-98.5) and NPV was 73.9% (95% CI 66.4-81.3); PPV for STDR detection was 96.7% (95% CI 92.1-100)) and NPV was 93.5% (95% CI 90.0-97.1).Conclusion: Smartphone-based NM retinal camera had fairly high sensitivity and specificity for detection of DR and STDR in this clinic-based study. Further studies are warranted in other settings. [ABSTRACT FROM AUTHOR]

Problem: In the Katherine region, Northern Territory, barriers to eye care for Aboriginal and Torres Strait Islander people include unclear eye care referral processes, challenges coordinating patient eye care between various providers, complex socioeconomic determinants and a lengthy outpatient ophthalmology waiting list. Design: Mixed methods participatory approach using a regional needs analysis, clinical file audit and stakeholder survey, to develop, implement and monitor quality improvement strategies. Setting: Collaboration with Aboriginal Community Controlled Health Services and regional eye care stakeholders in the Katherine region. Key measures for improvement: Clinical audit data captured frequency and rates of primary eye checks, ophthalmology referrals and spectacle prescriptions. A survey was developed and applied to assess stakeholder perspectives of regional eye care systems. Strategy for change: Quality improvement strategies informed by regional data (clinical audits and survey) included increasing service delivery to match eye care needs, primary eye care training for Aboriginal Community Controlled Health Services staff, updating Aboriginal Community Controlled Health Services primary care templates and forming a regional eye care coalition group. Effects of change: Post‐implementation, rates and frequency of recorded optometry examinations, number of spectacles prescribed and rates of annual dilated fundus examinations for patients with diabetes increased. There was a decrease in the number of patients with diabetes who had never had an eye examination. Eye care stakeholders perceived a marked improvement in the effectiveness of the regional eye care system. Lessons learnt: Our findings highlight the importance of engaging services and stakeholders to ensure a systems approach that is evidence‐informed, contextually appropriate and reflects commitment to improved eye health outcomes. [ABSTRACT FROM AUTHOR]