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aime E Dickerson Jnr8,91The Williamson Eye Center, Baton Rouge, LA, USA; 2Vold Vision, Fayetteville, AR, USA; 3Grene Vision Group, Wichita, KS, USA; 4Mercy Eye Specialists, Springfield, MO, USA; 5Buffalo Ophthalmology, Williamsville, NY, USA; 6Morris Eye Group, Encinitas, CA, USA; 7Arthur M Cotliar Eye Care and Surgery, New York, NY, USA; 8North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA; 9Sight Sciences, Inc., Menlo Park, CA, USACorrespondence: Jaime E Dickerson Jnr, Email [email protected] Purpose: To provide extended safety and effectiveness follow-up for eyes treated with circumferential canaloplasty and trabeculotomy (CP+TR) that were included in the 12-month ROMEO study. Setting: Seven multi-subspecialty ophthalmology practices located in 6 states (Arkansas, California, Kansas, Louisiana, Missouri, and New York). Design: Retrospective, multicenter, IRB approved. Subjects: Eligible eyes had mild–moderate glaucoma and were treated with CP+TR with cataract surgery or as a standalone intervention. Methods: Main outcome measures were mean IOP, mean number of ocular hypotensive medications, mean change in number of medications, proportion of patients with a ≥ 20% reduction in IOP or with IOP ≤ 18 mmHg, and proportion of patients medication free. Safety outcomes were adverse events and secondary surgical interventions (SSI). Results: Eight surgeons at 7 centers contributed 72 patients stratified by pre-operative intraocular pressure (IOP); > 18 mmHg (Grp1), ≤ 18 mmHg (Grp2). Mean follow-up of 2.1 years (min 1.4, max 3.5). 2-year IOP (SD) was 15.6 mmHg (− 6.1 mmHg, − 28% from baseline) on 1.4 medications (− 0.9, − 39%) for Grp1 with cataract surgery; 14.7 mmHg (− 7.4 mmHg, − 33% from baseline) on 1.6 medications (− 0.7, − 15%) for Grp1 standalone, 13.7 mmHg (− 0.6 mmHg, − 4.2%) on 1.2 medications (− 0.8, − 35%) for Grp2 with cataract surgery, 13.3 mmHg (− 2.3 mmHg, − 14.7%) on 1.2 medications (− 1.0, − 46%) for Grp2 standalone. The proportion of patients at 2 years with either a ≥ 20% IOP reduction or IOP between 6 and 18 mmHg and no increase in medication or SSI was 75% (54 of 72, 95% CI 69.9%, 80.1%). One-third of patients (24 of 72) were medication free whereas 9 of 72 were pre-surgical. No device-related adverse events during extended follow-up; 6 eyes (8.3%) required additional surgical or laser intervention for IOP control after 12 months. Conclusion: CP+TR provides effective IOP control that is sustained for 2 years or more. [ABSTRACT FROM AUTHOR]

Purpose: To assess the knowledge of nursing staff on ocular care in medical intensive care unit (ICU) and to compare the incidence of ocular surface disorders in patients of medical ICU pre‑ and post‑training. Methods: Two hundred patients admitted in medical ICU for more than 24 h underwent a detailed ocular examination along with documentation of ICU stay, ventilation status, and Glasgow coma scale (GCS) scoring. An assessment on ocular care knowledge among the nursing staff of medical ICU was done. They were further given training in the form of audio‑visuals and demonstration, and an eye care protocol was given to them. The second phase of the study was carried out in the same manner. A comparison was made between pre‑training and post‑training incidence of ocular surface disorders among ICU patients. Results: Ventilated patients had more eye discharge. Incidence of eye discharge was more in patients with duration of stay of more than 7 days in ICU. Ocular surface disorders closely correlated with the degree of lagophthalmos. There was significant reduction in ocular morbidity following ocular care training of the nursing staff. Conclusion: Eye care is a very important part of nursing care in sedated and ventilated patients in the ICU. Ophthalmic consultations are routinely needed in ICU subjects who are hospitalized for more than 1 week or if the ICU staff suspects any eye problems. Purpose: To assess the knowledge of nursing staff on ocular care in medical intensive care unit (ICU) and to compare the incidence of ocular surface disorders in patients of medical ICU pre‑ and post‑training. Methods: Two hundred patients admitted in medical ICU for more than 24 h underwent a detailed ocular examination along with documentation of ICU stay, ventilation status, and Glasgow coma scale (GCS) scoring. An assessment on ocular care knowledge among the nursing staff of medical ICU was done. They were further given training in the form of audio‑visuals and demonstration, and an eye care protocol was given to them. The second phase of the study was carried out in the same manner. A comparison was made between pre‑training and post‑training incidence of ocular surface disorders among ICU patients. Results: Ventilated patients had more eye discharge. Incidence of eye discharge was more in patients with duration of stay of more than 7 days in ICU. Ocular surface disorders closely correlated with the degree of lagophthalmos. There was significant reduction in ocular morbidity following ocular care training of the nursing staff. Conclusion: Eye care is a very important part of nursing care in sedated and ventilated patients in the ICU. Ophthalmic consultations are routinely needed in ICU subjects who are hospitalized for more than 1 week or if the ICU staff suspects any eye problems. [ABSTRACT FROM AUTHOR]

This document is a letter written by Tanu Rajput, Jyoti Mahawar, and Mahendra Singh in response to a study titled "The Prevalence and Severity of Acquired Blepharoptosis in US Eye Care Clinic Patients and Their Receptivity to Treatment." The authors express appreciation for the study's insights into the prevalence of acquired blepharoptosis and the receptivity of patients to treatment. However, they suggest further exploration of certain aspects, such as the reliance on patient self-assessment without quantitative measurements by a clinician, the lack of a control group for comparison, the limited generalizability of the findings, the lack of longitudinal follow-up, and the potential confounding factors that could influence patients' perceptions of ptosis severity. The authors hope that their suggestions will contribute to further research and improvements in the field of ophthalmology. [Extracted from the article]

This paper describes three organizations devoted to various aspects of the history of eye and vision care. The Optometric Historical Society, founded in 1969, strives to promote the study, documentation and appreciation of optometry history. The Ophthalmic Antiques International Collectors' Club, founded in 1982, and the Ocular Heritage Society, founded in 1984, are societies of collectors of vision aids and other objects related to eye and vision care, and they work to promote the study of ophthalmic antiques. [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]

Purpose: Dry eye disease affects hundreds of millions of people worldwide and is one of the most common causes for visits to eye care practitioners. The fluorescein tear breakup time test is currently widely used to diagnose dry eye disease, but it is an invasive and subjective method, thus resulting in variability in diagnostic results. This study aimed to develop an objective method to detect tear breakup using the convolutional neural networks on the tear film images taken by the non-invasive device KOWA DR-1α. Methods: The image classification models for detecting characteristics of tear film images were constructed using transfer learning of the pre-trained ResNet50 model. The models were trained using a total of 9,089 image patches extracted from video data of 350 eyes of 178 subjects taken by the KOWA DR-1α. The trained models were evaluated based on the classification results for each class and overall accuracy of the test data in the six-fold cross validation. The performance of the tear breakup detection method using the models was evaluated by calculating the area under curve (AUC) of receiver operating characteristic, sensitivity, and specificity using the detection results of 13,471 frame images with breakup presence/absence labels. Results: The performance of the trained models was 92.3%, 83.4%, and 95.2% for accuracy, sensitivity, and specificity, respectively in classifying the test data into the tear breakup or non-breakup group. Our method using the trained models achieved an AUC of 0.898, a sensitivity of 84.3%, and a specificity of 83.3% in detecting tear breakup for a frame image. Conclusions: We were able to develop a method to detect tear breakup on images taken by the KOWA DR-1α. This method could be applied to the clinical use of non-invasive and objective tear breakup time test. [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]

Background: Despite the high prevalence of ocular complications in patients admitted to the intensive care unit (ICU), eye care, as an important component of the care plan, has not received much attention from nurses. To improve the quality of eye care, the challenges and concerns of ICU nurses should be studied deeply. Thus, the present study aimed at exploring the challenges faced by ICU nurses in taking care of patients admitted to the ICU. Methods: The present conventional qualitative content analysis study was carried out on 11 nurses and 3 head nurses selected purposefully by observing the maximum variation. The data were collected through face-to-face, in-depth, and semi-structured interviews. All data were recorded, transcribed, and analyzed using the conventional content analysis method proposed by Graneheim and Lundman (Nurse Educ Today 24:105–12, 2004). The Max Q Data software 2020 was run to record the interviews and extract codes from the transcriptions. Results: The participants' mean age was 37.14 ± 6.41 years and their average work experience in ICU was 10.29 ± 7.63 years. The core category that emerged from data analysis was "the lack of an evidence-based approach", which was subdivided into five categories: "education, the missing link", "nurses' inadequate professional competence", "unsafe nursing care", "organizational requirements", and "difficulty in eye care evaluation". Conclusion: Evidence-based practice plays a minor role in the field of eye care in Iran, despite its critical importance. Thus, the Ministry of Health and Medical Education of Iran is recommended to adapt the clinical guidelines so that more attention is paid to this field. [ABSTRACT FROM AUTHOR]

On August 21, 2022, more than 100 individuals from at least nine different states gathered at Wills Eye Hospital in Philadelphia. Each of the three major eye care professions in the United States was amply represented. The occasion was to celebrate the contributions of John McAllister, Sr. and his descendants, whose early efforts led to the advancement of scientific knowledge, and to the evolution of eye care in the United States. John McAllister is widely regarded as the father (or grandfather) of optometry, since his work and the work of his progeny led to the beginning of optometry as an independent profession. The highlight of the event was the dedication of a historical marker honoring the ophthalmic legacy of the McAllister Family. The marker is situated in Old Town Philadelphia, very near where John’s original optical shoppe was located. The three eye care professions— opticianry, ophthalmology, and optometry—worked hand in hand to make this remarkable achievement possible. This paper tells the story of how and why it all came about. [ABSTRACT FROM AUTHOR]

In this article three interesting glaucoma cases are discussed alongside the evidence-based approach underpinning management decisions. All cases presented at the Cardiff University Ophthalmic Diagnostic and Treatment Centre (ODTC) which ran between July 2020 and August 2021 within the Cardiff University School of Optometry and Vision Sciences. The ODTC represented a collaborative partnership between Cardiff University and Cardiff and Vale University Health Board. The article highlights the benefits that result from collaborative working between primary care optometry and secondary care ophthalmology. The importance of developments such as the ODTC and the key advantages of this service in supporting the delivery of eye care and providing high-quality supervised clinical experience for optometrists are considered. [ABSTRACT FROM AUTHOR]

The influence of mass broadcasting and publishing media has been utilised to deliver public messaging for a range of health conditions. Newer information channels, such as social media, have led to renewed concerns about the propagation of health misinformation through these media that are largely unchecked. The purpose of this study was to identify information channels that patients were most likely to utilise when seeking information on different soft contact lens options, with specific evaluation of differences between established contact lens markets and between existing lens wearers and non-wearers. The study outcomes showed that eye care practitioners (ECPs), acquaintances and traditional forms of media such as the television were some of the most popular approaches for learning more about contact lens brands. Although when grouped together internet sources are marginally more popular, the top three were emails, official manufacturers' websites and social networking sites. Although nearly a quarter reported they would seek expert advice from ECPs, for all groups the influence of solely utilising the ECP was below expected levels, showing that patients may utilise a range of sources in their decision-making process. The older age group (60-70 years) tended to rely more on friends/family/acquaintances than on ECPs compared to their younger counterparts; TV was a less popular information channel for the over-60s than it was for younger age groups; and numerous intercountry differences were also noted. Almost twice as many contact lens wearers would seek ECP advice than non-wearers and were more receptive to email communications (by ~2.5 times). The proportion of non-wearers who would consult known acquaintances was higher than for contact lens wearers. These findings could facilitate the introduction of tailored patient communications, ensuring the promotion of reliable information, and ECPs should consider providing educational information and support resources using multiple communication channels as mechanisms that may enhance patient care. [ABSTRACT FROM AUTHOR]

Background: Eye health is essential for quality-of-life. The present study aimed to design an eye care behaviors assessment instrument for the student community and evaluate its psychometric properties. Methods: The present mixed-method cross-sectional study was conducted in two sections using Creswell and Plano Clark methods for instrument development. The study was conducted in Isfahan, Iran, in 2021. The first section (textual analysis and qualitative research) explained and developed the instrument's fundamental items. This section included in-depth, semistructured interviews with 21 students and eight experts. The second section measured the psychometric properties of the instrument. Twenty students assessed the instrument's qualitative and quantitative face validity in this section. The instrument's content validity ratio (CVR) and content validity index (CVI) were evaluated. In addition, exploratory factor analysis (performed by 251 students) was used to establish construct validity. Internal and test-retest reliability was determined using Cronbach's alpha and intraclass correlation coefficients (ICC), respectively. Results: During face and content validity assessment, a 37-item questionnaire was finalized. Exploratory factor analysis led to the identification of three factors, including "examinations and glasses-related behaviors," "symptom-related behaviors," and "screen-related behaviors." The three extracted factors accounted for 37.9% of the variance. Cronbach's alpha was equal to 0.874 when evaluating internal consistency, and the ICC value for the total score of the questionnaire was 0.885 (0.810-0.941), indicating excellent test-retest reliability. Conclusions: These results demonstrate the questionnaire's validity and reliability. This instrument assesses the prevalence of university students' most significant eye health risk behaviors. Consequently, it helps prevent eye problems. [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: The aim of this paper was to present a theoretical study of how poorly measured individual parameters affect the optical performance of progressive addition lenses (PALs). Modern progressive lenses can be prescribed based on parameters such as vertex distance, pantoscopic and wrap angles. These parameters can be measured from the lens wearer using specific devices; however, not all of them can be measured with the same precision, and the impact of measurement errors on the lens performance is still unknown. Methods: Data from 1900 patients were used to simulate the performance of four PAL designs with different degrees of complexity: perfect individual design, individual design with induced errors in the individual parameters, optimised design and conventional/basic design. For each patient and design, a quality metric was calculated to describe the optical performance of the lens. Results: The design having the best performance was the perfect individual design, followed by the individual design with induced errors, the optimised design and finally the conventional/basic design. Conclusions: Individual designs with measurement errors have better optical performance than lenses with less complexity, such as the optimised or conventional designs. This knowledge is useful for the eye care professional to make informed choices when dispensing these lenses. [ABSTRACT FROM AUTHOR]

Purpose: To explore the effects of cyclosporine A (CsA) in the management of atopic keratoconjunctivitis (AKC). Methods: Open single‐group interventional consecutive cohort study (case series) at a single eye care facility in the UK. We reviewed the electronic patient records of 99 children and young people (CYP) aged 3.4–18 years with AKC treated with topical CsA 1 mg/ml. Main outcome measures were number of prescriptions and hospital clinic visits over 12 months before and after the start of CsA and the proportion of CYP affected by adverse effects. Results: The median number of inflammatory episodes requiring treatment with topical corticosteroids (tCS) fell from 3 (interquartile range IQR 1–4) during the 12 months prior to CsA to 1 (IQR 0–3) during the 12 months after, excluding tCS prescriptions with the first CsA prescription (Wilcoxon signed ranks test, 2 tailed, p < 0.01). In the 12‐month period following initiation of CsA 1 mg/ml with concomitant prescription of tCS (n = 66), daily dosage of steroids was reduced in 62 CYP (93.9%), and they were discontinued in 43 (65.2%). The median number of hospital visits fell from 4 (IQR 3–6) to 3 (IQR 2–5; Wilcoxon p < 0.01). Adverse events leading to discontinuation of CsA were stinging (instillation site pain; 9/99, 9%) and a transient skin rash (1/99, 1%). Conclusions: Off‐label use of commercial preparations of CsA 1 mg/ml significantly reduces the need for concomitant topical corticosteroids and hospital clinic visits in CYP with AKC. Stinging and skin rash can lead to discontinuation. [ABSTRACT FROM AUTHOR]

Background: Current research in the realm of teleoptometric examinations is largely focused on the refractive and ocular health components of the exam. The purpose of this study was to evaluate the validity of binocular vision and accommodative testing in a tele-optometric examination compared to an in-person examination. Methods: Thirty students, ≥18 years old, at the Illinois College of Optometry were recruited to participate in this study. A teleoptometric examination was completed using the DigitalOptometrics platform, followed by a standard in-person examination. The following tests were performed in both examinations: near horizontal heterophoria by von Graefe, near negative and positive fusional vergences (NFV and PFV, respectively) by Risley prism, and accommodative testing with fused cross-cylinder (FCC). Results: The mean near horizontal heterophoria by von Graefe was 2.09Δ ± 6.73∆ exophoria in the tele-optometric examinations and 2.07Δ ± 6.54∆ exophoria in the in-person examinations, with no statistically significant difference between the two examinations (p=0.98). The mean NFV break and recovery in the tele-optometric examination were 10.85∆ ± 3.17∆ and 7.08∆ ± 3.03∆, respectively, and 23.40∆ ± 7.71∆ and 15.38∆ ±7.31∆, respectively, in the in-person examination, with a statistically significant difference (for both, p<0.0001). The mean PFV break and recovery in the tele-optometric examination were 13.50Δ ± 4.24Δ and 9.36Δ ± 4.68Δ, respectively, and 25.86Δ ± 10.48Δ and 16.54Δ ± 7.18Δ, respectively, in the inperson examination, with a statistically significant difference (break: p=0.001, recovery: p=0.004). Agreement of NFV and PFV between the two examinations was poor. The average FCC in the tele-optometric versus in-person examination was +0.67 D ± 0.51 D and +0.96 D ± 0.33 D, respectively, with a statistically significant difference between the two examinations (p=0.012). Conclusions: The tele-optometric and inperson examinations had fair agreement on near heterophoria but poor agreement on break and recovery values of NFV and PFV. Accommodative testing with FCC was not equivalent between the two exams. [ABSTRACT FROM AUTHOR]

Introduction: Coping strategy is the mechanism by which patients adjust to the condition they face. It can be adaptive or maladaptive. A maladaptive coping strategy is a harmful and ineffective way of dealing with stress or anxiety. It is common among patients with chronic illnesses. Despite Ethiopia having a greater glaucoma prevalence, there was no evidence of patients with glaucoma using maladaptive coping mechanisms. Objective: The main goal of this study was to evaluate the magnitude of maladaptive coping strategy use and the factors that associate with it among adult glaucoma patients enrolled in the Tertiary Eye Care and Training Center at the University of Gondar in Northwest Ethiopia in 2022. Methods and Materials: At the University of Gondar, Tertiary Eye Care and Training Center, a facility-based cross-sectional study was carried out on a sample of 423 glaucoma patients chosen by a systematic random sampling technique from May 15 to June 30, 2022. Optometrists conducted an interview with the study subject and reviewed the medical record, and administered a pretested, structured questionnaire of the brief cope inventory assessment. In the multivariable logistic regression, binary logistic regression was performed to identify the related factors, and significance was taken into account when the p-value was less than 0.05 at the 95% confidence interval. Results: The study found that among study participants 50.1% (95% CI: 45.1– 54.5%) had a maladaptive coping strategy. Female sex (AOR=2.031, 95% CI:1.185– 3.480), chronic medical illness (AOR=1.760, 95% CI:1.036– 2.989), bilateral glaucoma (AOR=2.321, 95% CI: 1.328– 4.055), receiving both drug and surgery treatment (AOR=1.895, 95% CI: 1.002– 3.585), severe visual impairment (AOR=2.758, 95% CI:1.110– 6.852), absolute glaucoma (AOR=2.543, 95% CI:1.048– 6.169), duration of diagnosis > 12 months (AOR=3.886, 95% CI: 2.295– 6.580) were significantly associated with a maladaptive coping strategy. Conclusion and Recommendation: Half of the participants had a maladaptive coping strategy. It is better to set and plan strategies that enable the integration of coping strategy care into the current treatment of patients with glaucoma to encourage positive coping strategies instead of maladaptive ones. [ABSTRACT FROM AUTHOR]

Purpose: To determine the pattern of pediatric ocular morbidities in western India. Methods: This was a retrospective longitudinal study that included all consecutive children aged ≤15 years who presented to the outpatient department of a tertiary eye center for the first time. Patient demographics, best-corrected visual acuity (BCVA), and ocular examination data were compiled. Subgroup analysis was also performed based on age group (years): ≤5, 5–10, and >10–15. Results: A total of 11,126 eyes of 5563 children were included in the study. The mean age of the study population was 5.15 (±3.32) years with males (57.07%) being predominant. Approximately half of the patients (50.19%) were under the age of 5 years, followed by those aged 5–10 years (45.1%) and >10–15 years (4.71%). Among the study eyes, the BCVA was ≥20/60 in 58.57%, indeterminable in 35.16%, and <20/60 in 6.71%. The commonest ocular morbidity noted was refractive error (28.97%) followed by allergic conjunctivitis (7.64%) and strabismus (4.95%) in the total study cohort and also after age stratification. Conclusion: Refractive error, allergic conjunctivitis, and strabismus are the major causes of ocular morbidity in pediatric eyes at a tertiary care center. Planning screening programs at the regional and national levels is crucial to decreasing the burden of eye disorders. These programs also need to have a suitable referral mechanism established and be smoothly connected to primary and secondary health-care centers. This will help to assure quality eye care delivery, while also reducing the strain of overworked tertiary centers. [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]

Purpose: To assess the differences in the pattern of presentation of glaucoma emergency conditions during the various phases of pandemic-related travel restrictions: first wave-related lockdown, unlock period, and the second wave-related lockdown. Methods: The number of new emergency glaucoma conditions, the various diagnoses, and the total number of all new glaucoma patients presenting to the glaucoma services at five tertiary eye care centers in south India from 24th March 2020 to 30th June 2021 were collected from the electronic medical records and were analyzed. The data were compared with the corresponding time period in the year 2019. Results: In total, 620 patients presented with an emergency glaucoma diagnosis during the first wave-related lockdown as against 1337 during the same period in 2019 (P < 0.0001). During the unlock period, 2659 such patients visited the hospital compared with 2122 in 2019 (P = 0.0145). During the second wave-related lockdown, there were 351 emergency patients compared with 526 patients in 2019 (P < 0.0001). Lens-induced glaucomas (50.4%) and neovascular glaucoma (20.6%) were the most common diagnoses during the first wave-related lockdown. During the unlock period, there was a greater proportion of neovascular glaucoma (P = 0.0123). The second wave-related lockdown had a greater proportion of phacolytic glaucomas (P = 0.005) and acute primary angle closure (P = 0.0397) patients. Conclusion: The study demonstrates that emergency glaucoma care was grossly underutilized by the people during the lockdowns. Trivial conditions like cataracts or retinal vascular diseases if not treated appropriately may progress to become emergencies in the future. [ABSTRACT FROM AUTHOR]

Purpose: To examine the eye care practice in the Mumbai Metropolitan Region (MMR). Methods: This study consisted of primary and secondary research conducted in five zones of MMR. The primary research included interviews with the patients, eye care providers, and key opinion leaders. The secondary research included analyzing data from the professional ophthalmology societies, public health domain, and health insurance providers. We divided people into three economic classes by annual income – low (1.8 m). We analyzed the collected data to estimate the eye care demand–supply, quality of eye care, health-seeking behavior, gap in eye care delivery, and eye care expenditure. Results: We examined 473 key eye care facilities and interviewed 513 people. The ophthalmologist density in MMR was 80/million, and it was the highest in North MMR. Most ophthalmologists visited several facilities. Cataract surgery and glaucoma care coverage were better than other specialties; it was poor for oncology and oculoplastic services. Annual eye examination practice was poor in the low- and middle-income groups than in the high-income group (48%–50% vs. 85%). Most people preferred visiting eye care facilities within 5 km of their residence. Out-of-pocket spending was between 60% and 83%. Lower-income group people preferred public facilities. Conclusion: MMR eye care needs further improvement in affordable and accessible eye care, health literacy, public health surveillance, research into the application of newer technologies to provide less-expensive home care for the elderly and minimize their hospital visits, and collection and analysis of big data to address city-specific eye health issues. [ABSTRACT FROM AUTHOR]

Purpose: The study intends to evaluate the demographic and clinical profile of pediatric patients (0–18 years) attending six vision centers (VCs) of a tertiary eye care facility in south India. Methods: This is a cross-sectional observation study conducted at six major peripheral VCs of a tertiary eye care facility in South India from June 20 to Dec 20. All children presenting at the VCs under a base hospital (BH) in Pondicherry, whose parents gave consent were included. Data were entered by the ophthalmic assistants in the VC and cross checked by the principal investigator at the BH. Results: A total of 250 pediatric patients were brought to the VCs during the study period, predominantly males (60.8%), with a mean age of 8.2 ± 4.5 years (0–18 years). Half of them were staying within 5 km from the VCs. Most children were escorted by their parents (88%), and the expenditure of travel to the VC was affordable for most of the parents (75%). Also, 53.6% of patients were in their primary school, while schooling had not started for 28% of children. Visual acuity (VA) could be assessed only for school-going children and older children due to lack of age-matched VA assessment tools. Most children (91.3%) had uncorrected VA better than or equal to 6/18 in the better eye, and approximately 3% had VA worse than 6/60. All patients had best corrected VA of 6/6–6/18 after cycloplegic refraction. Most children reported to the VC for allergic conjunctivitis (25%), followed by refractive error (13%) and squint (10.4%). Urgent referral to the BH was made for 47 children. Conclusion: Primary eye care in pediatric population-I (PREPP-I) showed that most children can be treated at the VCs and only one-fifth of the children require active intervention at higher referral centers. Further study on satisfaction of services provided for pediatric patients in these VCs and barriers of not reporting to the BH when referred are considered for the PREPP-II study. [ABSTRACT FROM AUTHOR]

Purpose: To study the prevalence and determinants of compliance with spectacle wear among school-age children in South India who were given spectacles free of charge under a school vision screening program. Methods: A cross-sectional, descriptive study was performed. The participants were recruited from the school from Tirunelveli and Tuticorin districts of Tamil Nadu, where a school vision screening camp was conducted between January 2012 and October 2012. The school screening was performed under "Lavelle Pediatric Eye Care Project". Of the 129,720 children examined of 249 schools, 4253 of children had refractive error and 3333 were prescribed and dispensed spectacles. A total of 683 children were interviewed, who were not wearing glasses on follow-up. Results: About 20% of the participants (683/3333) were not wearing their spectacles at examination. The most common reasons given for non-wear were lost (44.9%) or broken (35.3%) spectacles. There was no gender preference on compliance to spectacles. Conclusion: Compliance with spectacle wear is less even when spectacles are provided free of cost, particularly in children among the age group of 5–15 years. Because factors such as type of school, area (urban or rural), parent's income, occupation, and their education were not significantly affecting the compliance of spectacle wear, proper encouragement and counseling of the parents and the child become extremely important. [ABSTRACT FROM AUTHOR]

Purpose: To determine the level of awareness and knowledge about glaucoma surgery and post-surgery counseling amongst paramedical staff at a tertiary eye-care hospital. Methods: This observational cross-sectional study included a random sample of 94 hospital personnel: 37 general nurse midwives, 47 ophthalmic assistants, and 10 patient caretakers (PCTs). Participants were administered a questionnaire about glaucoma surgery and post-surgery counseling of patients. Results: The study included 41 (43.6%) females and 53 (56.4%) males. The mean age of the participants was 24.85 ± 4.54 years. All participants were aware of trabeculectomy surgery in glaucoma (100%). A total of 95.7% knew that surgery helps in controlling IOP, of whom 57 (60.6%) participants got information during their course of learning. Overall 53 (56.4%) believed that surgery is done when medication failure occurs, and 58 (61.7%) knew that surgery helps in preserving vision. A total of 63 (67.0%) participants knew to counsel patients to visit an ophthalmologist when called for and take the treatment as advised, whereas 74 (78.7%) correctly said to visit an ophthalmologist immediately if pain/diminution of vision/discharge occurs. Overall, PCTs were found to be having significantly better knowledge (P = 0.01) compared to others and they also reported ophthalmologists as the chief source of information. Conclusion: This study revealed that paramedical staff had an excellent awareness of trabeculectomy surgery. However, the knowledge and counseling parts of the questionnaire revealed less than satisfactory responses. So, there is a need to continuously educate paramedical staff members so that they can help in propagating information about the role of glaucoma surgery and the importance of proper follow-up. [ABSTRACT FROM AUTHOR]

Purpose: While there are a few studies that show the prevalence of blindness and ocular morbidity in children, studies on socioeconomic factors in childhood cataracts are scarce. We aimed to study the socioeconomic status, education and occupation of the parents, consanguinity, and gender inequality among children presenting with cataracts. Methods: This was a hospital-based, prospective, descriptive study of 68 children with cataracts (aged 0–18 years). In addition to the data on clinical parameters and surgical management, we also collected data on age, gender, age at which the chief complaint was noticed, consanguinity of parents, socioeconomic class, and occupation and education of parents. All statistical analyses were performed using MedCalc statistical software (MedCalc Software 2019, Ostend, Belgium). Results: Sixty-eight children with pediatric cataract, out of which 36 were bilateral, were studied. Thirty children (44%) were in the age group of 1–5 years. Out of the 36 bilateral cataracts, 25 (69.44%) were males and 11 (30.56%) were females. Thirty (44.1%) had a delayed presentation. Also, 31% belonged to middle class and 28% belonged to lower middle class. Moreover, 65% of the mothers had an undergraduate education. Conclusion: There is a gender-based inequality and late presentation of childhood cataracts. To improve early detection, red reflex screening should be mandatorily done. Further studies are required to identify barriers to access of eye care specific to girls, in order to plan interventions to improve uptake of treatment. The lower socioeconomic status of the patients should be taken into account in the management of this disease. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of liposomal amphotericin B (L-AMB) for the treatment of fungal keratitis. Methods: Patients with fungal keratitis confirmed by potassium hydroxide (KOH) smear and/or confocal microscopy were administered topical L-AMB and randomized into three groups treated with three different formulations. The medication was administered two hourly till clinical improvement was achieved, followed by six hourly till complete resolution. The outcome measures were time to clinical improvement, resolution of epithelial defect, stromal infiltrate, hypopyon, extent and density of corneal opacity, neovascularization, and best corrected visual acuity (BCVA) at 3 months. Results: Mean age of the patients was 46.6 ± 14.8 years, and trauma with vegetative matter was the most common predisposing factor. Aspergillus flavus (36%) was the most common fungus cultured, followed by Fusarium (23%). Mean time to clinical improvement, time to resolution of epithelial defect, mean time to resolution of infiltrate, and time to resolution of hypopyon were 3.45 ± 1.38, 25.35 ± 8.46, 37.97 ± 9.94, and 13.33 ± 4.90 days, respectively, and they were comparable among the three groups. There was a significant difference between treatment failure and success cases in terms of days of presentation (P < 0.01), size of the epithelial defect (P-value 0.04), and infiltrate size at presentation (P-value 0.04). At 3 months follow-up, no statistically significant difference was noted in BCVA and mean scar size among groups. Conclusion: L-AMB in a gel form is an effective antifungal agent that promotes the healing of fungal ulcers with notably least vascularization and better tolerance. Trial registration number: CTRI/2020/04/024550 [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to determine the demographic profile and clinical characteristics in patients with Fuchs' endothelial corneal dystrophy (FECD) reporting to a tertiary eye care center in India. It is a retrospective, single-center, observational study. Methods: The study included 280 patients (559 eyes) diagnosed with FECD presenting between January 2013 and December 2020. The data was collected from the electronic medical record system of the institute. Patient data included demographic features, clinical characteristics, investigations, and surgical interventions. Results: The mean age of the patients was 62 years. Late-onset FECD (95.7%) was more common than early-onset FECD (4.3%). Male: female ratio for late-onset FECD and early-onset FECD was 1:1.65 and 3:1, respectively. More than one-third of the patients had associated systemic history. Preexisting ocular diseases were seen in 5.9% of eyes. Blurring of vision was seen in 383 eyes (68.5%), 13 eyes (2.1%) had glare, and 163 eyes (29.2%) were asymptomatic. A total of 113 surgical interventions were done in 108 eyes (including repeat transplants). Only cataract surgery was done in 40 (7.2%) eyes, whereas penetrating keratoplasty, Descemet stripping endothelial keratoplasty, and Descemet membrane endothelial keratoplasty without or with cataract surgery (sequential or triple procedure) were done in 12 (2.1%), 47 (8.4%), and 14 (2.5%) eyes, respectively. Conclusion: Patients with FECD present mostly during the sixth decade. Posterior lamellar keratoplasty is the most common transplant procedure being performed on FECD patients. [ABSTRACT FROM AUTHOR]

Purpose: To describe the demographics, clinical profile, and outcomes of ocular siderosis in patients presenting to a multi-tier ophthalmology hospital network in India. Methods: This cross-sectional and hospital-based study included 3,082,727 new patients who presented between August 2010 and December 2021. Patients with a clinical diagnosis of ocular siderosis in at least one eye were included. Results: Overall, 58 eyes of 57 patients (0.002%) were diagnosed with ocular siderosis. The majority were men (96.49%) and had unilateral (98.25%) affliction. The most common age group at presentation was during the third decade of life with 24 patients (42.11%). A clear history of ocular trauma was documented in 47 patients (81.03%). Major clinical signs included corneal pigment deposition in nearly half of the eyes (27/58 eyes, 46.55%), corneal scar (20/58 eyes, 34.48%), cataract (22/58 eyes, 37.93%) and retinal detachment (11/58 eyes, 18.96%). The intraocular foreign body (IOFB) was anatomically localized in a majority of the eyes (i.e., 45/58 eyes, 77.59%). The most common location of the IOFB was in the posterior segment (22/58 eyes, 37.93%). The eyes that underwent a vitreoretinal surgery with removal of IOFB had a slightly better BCVA (1.0 ± 1.01) when compared to eyes with non-removal of IOFB (1.58 ± 1.00). Conclusion: Ocular siderosis is a rare sight-threatening entity, with half of the affected eyes exhibiting severe visual impairment. Majority of the eyes in ocular siderosis will have a detectable IOFB. Surgical removal of IOFB may lead to a better visual gain when compared to non-removal. [ABSTRACT FROM AUTHOR]

India is a country with a huge rural population that has substantial unmet eye care needs. A majority of eye care facilities and eye care professionals are in urban and semi-urban areas. The Challenges of Quality Rural Eye Care Delivery Being located in a remote backward region, there were several unique challenges faced by our hospital in the provision of quality eye care to the rural masses. A dedicated infrastructure for eye care was established in 2000 with the goal to combat the seasonal imbalance of patient attendance by providing round-the-year quality eye care service delivery. [Extracted from the article]

Background: Community engagement has been endorsed as a key strategy to achieving integrated people-centered eye care that enables people and communities to receive a full spectrum of eye care across their life-course. Understanding the ways communities are engaged in eye care, to what degree participation is achieved, and the factors associated with intervention implementation is currently limited. Objective: The scoping review aimed to assess how community engagement is approached and implemented in eye care interventions in low- and middle-income countries, and to identify the barriers and facilitators associated with intervention implementation. Methods: Searches were conducted across five databases for peer-reviewed research on eye care interventions engaging communities published in the last ten years (January 2011 to September 2021). Studies were screened, reviewed and appraised according to Cochrane Rapid Reviews methodology. A hybrid deductive-inductive iterative analysis approach was used. Results: Of 4315 potential studies screened, 73 were included in the review. Studies were conducted across 28 countries and 55 targeted populations across more than one life-course stage. A variety of community actors were engaged in implementation, in four main domains of eye care: health promotion and education; drug and supplement distribution and immunization campaigns; surveillance, screening and detection activities; and referral and pathway navigation. With the approaches and level of participation, the majority of studies were community-based and at best, involved communities, respectively. Involving community actors alone does not guarantee community trust and therefore can impact eye care uptake. Community actors can be integrated into eye care programs, although with varying success. Using volunteers highlighted sustainability issues with maintaining motivation and involvement when resources are limited. Conclusion: This scoping review provides researchers and policy makers contextual evidence on the breadth of eye care interventions and the factors to be considered when engaging and empowering communities in integrated people-centered eye care programs. [ABSTRACT FROM AUTHOR]

Inefficient management of resources and waiting lists for high-risk ophthalmology patients can contribute to sight loss. The aim was to develop a decision support tool which determines an optimal patient schedule for ophthalmology patients. Our approach considers available booking slots as well as patient-specific factors. Using standard software (Microsoft Excel and OpenSolver), an operations research approach was used to formulate a mathematical model. Given a set of patients and clinic capacities, the model objective was to schedule patients efficiently depending on eyecare measure risk factors, referral-to-treatment times and targets, patient locations and slot availabilities over a pre-defined planning horizon. Our decision support tool can feedback whether or not a patient is scheduled. If a patient is scheduled, the tool determines the optimal date and location to book the patients' appointments, with a score provided to show the associated value of the decisions made. Our dataset from 519 patients showed optimal prioritization based on location, risk of serious vision loss/damage and the referral-to-treatment time. Given the constraints of available slots, managers can input hospital-specific parameters such as demand and capacity into our model. The model can be applied and implemented immediately, without the need for additional software, to generate an optimized patient schedule. [ABSTRACT FROM AUTHOR]

Aim. Multisystemic physiological changes in pregnancy can result in tear film and refractive changes in the eye. We report dry eye prevalence in pregnant women using Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire. Methods. The SPEED questionnaire was self-administered cross-sectionally to 428 pregnant women (mean age: 26.8 ± 4.4 years) with clinically confirmed pregnancy from two obstetric clinics in Chennai, India. Subjects with predisposing risk factors for dry eye were excluded from the study. Subjects were categorized as normal, moderate, and severe dry eye based on the SPEED score. Results. Among the women, 48.5% of the subjects had symptoms like dryness, grittiness or scratchiness, soreness or irritation, burning or watering, or eye fatigue. About 2.3% had moderate dry eye according to SPEED questionnaire criteria. Eye fatigue was the most reported symptom and was present in 76.4% of women. The symptom frequency score and severity score had a strong and significant correlation (r = 0.95 , P <.001). No significant correlation was noted among SPEED score vs age (r = − 0.02 , P >.05). No significant correlation was found between symptoms of dry eye and gravidity (ρ = − 0.006 , P >.05) and trimester (ρ = 0.38 , P >.05). Binary logistic regression showed that only occupational status and systemic condition was significantly associated with dry eye symptoms. Conclusion. About half the pregnant women at the visit reported having one or more dry eye-related symptoms. As per the composite SPEED questionnaire score, dry eye was not prevalent among pregnant women irrespective of their age, gravidity, and the trimester, but we found a majority of pregnant women reported to have experienced dry eye-related symptoms, though tolerable. Awareness about dry eye during pregnancy will improve eye care seeking behaviour in pregnant women. [ABSTRACT FROM AUTHOR]

Background: Monitoring ocular morbidity among pediatric patients requires regular follow-up visits. We found that the follow-up rate was poor among children in our setting. Therefore, we intended to assess the effectiveness of 2 interventions--(1) counseling and (2) SMS text messaging and phone calls--to improve the follow-up rates. Objective: This study aimed to evaluate the effectiveness of 2 interventions, counseling and SMS and phone calls group, as well as a routine standard care for improving the follow-up rate of pediatric patients. Methods: A Nonrandomized, quasiexperimental design was used. Children (aged 0-16 years) with ocular conditions requiring at least 3 follow-up visits during the study period were included. A total of 264 participants were equally allocated to the 3 intervention groups of (1) counseling, (2) SMS and phone calls, and (3) routine standard care group. A 20-minute counseling session by a trained counselor with the provision of disease-specific leaflets were given to those in the counseling group. For the second intervention group, parents of children received an SMS text 3 days before and a phone call 1 day before their scheduled follow-up visits. Participants allocated for the routine standard care group were provided with the existing services with no additional counseling and reminders. Participants attending 3 follow-ups within 2 days of the scheduled visit date were considered compliant. The difference in and among the proportion of participants completing all 3 follow-up visits in each group was assessed. Results: The demographic characteristics of the participants were similar across the study groups. Only 3% (8/264) of participants completed all 3 follow-up visits, but overall compliance with the follow-up, as defined by the investigators, was found to be only 0.76% (2/264). There was no statistically significant difference in the proportion of follow-up between the intervention groups. However, the proportion of participants attending the first and second follow-ups, as well as the overall total number of follow-ups, was more in the SMS and phone-call group followed by the counseling group. Conclusions: We did not find any evidence on the effectiveness of our interventions to improve the follow-up rate. The primary reason could be that this study was conducted during the COVID-19 pandemic. It could also be possible that the intensity of the interventions may have influenced the outcomes. A rigorously designed study during the absence of any lockdown restrictions is warranted to evaluate intervention effectiveness. The study also provides useful insights and highlights the importance of designing and systematically developing interventions for improving the follow-up rate and ensuring a continuum of care to children with visual disabilities in Nepal and similar contexts. [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]

Objective: To evaluate the effects of the Covid-19 pandemic on the profile of emergency eye-related visits and compare the findings with the same period before the pandemic. Methods: Cross-sectional study performed during one year at a reference eye hospital. Cases registered at the emergency Municipal Hospital Complex of Santo Andre, Brazil, between March, 2019 and February, 2020 were included in the study as the Pre-pandemic group. Cases registered between March, 2020 and February, 2021 were included as the Pandemic group. Cases were classified according to the International Classification of Diseases ICD-10 and Related Health Problems. Results: There was a decrease of 52.1% in the emergency eye care visits during the pandemic period (n=9,198) when compared to the pre-pandemic period (n=19,220), with significant reductions in nonspecific cases (-98.1%), postoperative visits (-67.0%), disorders of the conjunctiva (-54.1%), tear film (-49.4%) and refraction (-85.6%) during the pandemic period. Conditions such as retina disorders (+202.7%), sclera disorders (+76.2%), orbit disorders (+20.2%), glaucoma (+66.6%) and trauma (+19.4%) have shown increased rates, as well as those related to eyelids (+186.9%), cornea (+33.4%), uvea (+40.2%), and herpes (+55.3%). Conclusion: A drastic reduction in the number of eye-related emergency visits was observed during the Covid-19 pandemic, outlining a new profile of care, with higher frequency of sight-threatening conditions and lower frequency of contagious and non-specific diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: The epidemiological, clinical, and microbiological profiles of patients with infectious endophthalmitis comparing the traumatic and non-traumatic etiologies presented to a Tertiary Eye Care Center in the rural tribal areas of Gujarat. Methods: A retrospective review of the electronic medical records of 114 patients between January 2008 and December 2019 was carried out. All patients were diagnosed with clinical endophthalmitis, treated with Endophthalmitis Vitrectomy Study first intravitreal injection, and then undergone pars plana vitrectomy with intraocular antibiotics. Results: 61/114(53.5%) patients had non-traumatic postoperative (PO) and 53/114 (46.3%) had posttraumatic (PT) endophthalmitis. Males were predominant in all types of endophthalmitis. Significantly younger individuals constituted the PT group. Best-corrected visual acuity (BCVA) at presentation was <1/60 in the majority (94.2%) of patients, while the treatment outcome was variable in the etiology with respect to BCVA that improved to 6/60 in 27 (23.68%) eyes and >6/24 in 17 (15.7%) eyes. In addition, 23 (20.2%) did not have any perception of light, and no significant change was detected in the visual outcome (p=0.278) according to etiologies. Conclusion: Infectious endophthalmitis is a rare but serious sight-threatening complication. Aggressive and prompt treatment causes significant improvement in vision. Etiology does not have a significant impact on the outcome of EVS in PT cases. [ABSTRACT FROM AUTHOR]

Purpose: To assess real-world effectiveness and tolerability of fixed-dose combination netarsudil 0.02%/latanoprost 0.005% (FCNL) in management of glaucoma patients in a tertiary eye care center. Methods: This retrospective cohort study included glaucoma patients initiated on FCNL from January 2018 to July 2021 with at least 1-month follow-up. Demographic and clinical data were collected at baseline and at follow-up visits through 12 months. Patient-solicited side effects were recorded at each visit. Maximum glaucoma pharmacotherapy was defined as surgery/laser being the next treatment option following an intensive pharmacotherapy regimen, or when pharmacotherapy could not be increased due to allergy/intolerance or all pharmacologic mechanisms already being in use. Results: Seventy-nine eyes of 47 patients were included. Mean age was 67.7 ± 14.7 years. Baseline IOP was 18.7 ± 4.9 mmHg; mean change in IOP (∆IOP) each study visit compared to baseline ranged from − 1.6 ± 3.5 to − 4.4 ± 4.1 mmHg (all p < 0.05). The eyes on maximum glaucoma pharmacotherapy (73.4%) had similar ∆IOP compared to those on non-maximal therapy at each visit (p > 0.2 for all). Forty-three (54.4%) eyes were switched from a prostaglandin analog alone, producing a 1-month IOP reduction of − 4.7 ± 3.9 mmHg at 1 month which remained significant at each visit for the 12-month study period (all p < 0.05). Across all study visits, conjunctival hyperemia was documented in 26 (32.9%) eyes. Subjective blurry vision was reported in 22 (27.8%) eyes without significant worsening of visual acuity at any visit (all p > 0.05). Six (7.6%) and 7 (8.9%) eyes required further medical or surgical/laser intervention, respectively. Kaplan–Meier analysis revealed no significant difference in the need for subsequent medical or surgical intervention between those on maximum and non-maximal pharmacotherapy (p > 0.4). Conclusion: FCNL was well-tolerated and demonstrated a significant and sustained reduction in IOP, even as last-line therapy before incisional or laser surgery in those on maximum glaucoma pharmacotherapy. FCNL is a viable treatment option for glaucomatous eyes before consideration of surgical intervention. [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]

Background: Keratoconus (KC) is a progressive condition that usually affects young persons between their first and fourth decades. Myopia and irregular astigmatism are the common presentations which are proceeded by corneal steepening and thinning. Keratoconus is a progressive ectasia of the cornea that presents bilaterally, although often asymmetrical. Aim: To explore the experiences of KC patients attending public eye care facilities in Capricorn District of Limpopo province. Setting: Capricorn District, Limpopo province, South Africa. Methods: Descriptive qualitative phenomenology approach was used in the study to explore the lived experiences of patients diagnosed with KC, attending public eye care facilities. Purposive sampling was used to select 16 patients who were diagnosed with KC and referred for contact lens fitting. Data were collected through face-to-face, one-on-one interviews. Results: Patients reported to have developed gradual vision loss which worsened when they grew older. There was lack of knowledge of KC amongst patients and this was exacerbated by limited health literacy and vocabulary barriers. Patients had difficulty performing daily activities where some had dropped out of school while others worked at a slower pace and reduced working distances. Conclusion: Patients with KC received inadequate information on their condition due to limited health literacy and vocabulary barriers. Programmes to promote practitioner and patient education are required to improve the perceived service level provided to KC patients. Contribution: The findings of this study will assist to improve the experiences of KC patients on perceived service quality received from public facilities. [ABSTRACT FROM AUTHOR]

Background: Diabetes is increasingly prevalent in Indigenous women and increases their risk of developing diabetic retinopathy, an eye complication of diabetes and a common cause of vision loss in Canada, especially among adults. Early detection is the most effective approach to prevent vision loss and reduce the impact of diabetic retinopathy. Objective: This study examined enablers and barriers that influence the diabetes eye care behaviour of First Nations and Métis women with diabetes and at risk of diabetes. Methods: We conducted a descriptive qualitative study with 35 First Nations and Métis women with diabetes or at risk of diabetes in Saskatoon, Canada. Data were collected via four sharing circle discussions and were analysed using thematic analysis. Results: The study findings showed that understanding of diabetes eye care access and cost, and unsupportive interactions with health care practitioners, were barriers to diabetic retinopathy care behaviour. Conversely, the presence of eye complications, participants' resolve to manage diabetes, self‐efficacy and fear due to experiences of family members with diabetes enabled diabetes eye care. Conclusions: Our study advances knowledge in socio‐cultural factors influencing diabetic retinopathy care behaviour among First Nations and Métis women living with and at risk of diabetes. The study shows the need for further public health and health system interventions to address barriers and support Indigenous peoples with or at risk of diabetes to make informed health decisions. [ABSTRACT FROM AUTHOR]

Context: Considerable evidence of gender, ethnicity, thyroid dysfunction, and environmental factors including smoking influencing the development and progression of thyroid eye disease (TED). Settings and Design: Cross-sectional study of the clinical characteristics of 136 patients with TED who presented to the Orbit and Oculoplasty services at a tertiary eye care center in south India between October 2018 and June 2020. Results: Among the 136 patients (M: 61, F: 75), the mean age was 47.04 (SD ± 13.24) years. Hyperthyroid disease was present in 53%, hypothyroid disease in 40%, and 7.3% were euthyroid. Active disease was noted in 25% and inactive disease in 75% of patients. Active disease was present in 25% of hyperthyroid, 18.5% of hypothyroid, and 15% of euthyroid patients. Active TED showed statistically significant association toward development of greater severity of proptosis (P = 0.001), optic neuropathy (P = 0.004), and extraocular movement restriction (P < 0.001) as compared to inactive disease. Mild, moderate to severe, and sight-threatening TED was noted in 34.6%, 59.6%, and 6% of patients, respectively. Nine eyes had dysthyroid optic neuropathy, of which eight had either mild or no proptosis while one had moderate to severe proptosis. Conclusion: Prevalence of active as well as severe thyroid eye disease is common in our population. Recommendation for ophthalmological examination of patients even with milder disease especially when associated with decreased vision and signs of inflammation. Active disease is less common in euthyroid patients, thus necessitating maintaining the euthyroid status toward reducing disease activity and progression. [ABSTRACT FROM AUTHOR]

Purpose: To access knowledge, attitude, and practices of Eye care practitioners (ECPs) towards COVID-19 guidelines and to determine their knowledge about use of Personal Protective Equipment (PPE). Methods: A cross-sectional study was conducted in Tertiary Eye Hospitals of Rawalpindi and Islamabad from October 2020 to March 2021. A total of 270 Eye care practitioners currently working in public and private hospitals were included in this study. Non-probability convenient sampling technique was used. Data was collected from individuals through an interview-based questionnaire after taking consent. Data was coded and analyzed by using SPSS version 26. The Chi-square test was used for further analysis. Results: Mean age of participants was 29.85 ± 7.482 years, ranging from 18 to 65 years. Females (67%) were slightly out-numbered than males of the total sample. Moreover, 50% of the respondents had adequate knowledge about COVID-19 while only 39.3% had a positive attitude towards COVID-19. Hours of practice and years of experience had an association with knowledge. Good practices were observed by only 43.3% of the total sample. Practices had an association with the department of work of ECPs. Conclusion: There is scarcity of knowledge among ECPs about COVID-19 and its preventive measures. Less than 50% ECPs with positive attitude and good practices towards COVID-19 indicate a dire need to train them for use of PPEs. [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]

Health disparities exist across different linguistic groups. Language barriers in primary care can negatively affect access to healthcare services and the quality and safety of care at the end-of-life. This study will take a novel, in-depth look at the experience of language-and/or cultural-discordant care for adults from linguistic minority groups through the eyes of primary care physicians providing palliative and/or end-of-life care. Language and cultural discordance means that the physician and patient do not speak the same language or are not from the same cultural background. Qualitative data from primary care physicians (n = 12-24) providing language-discordant end-of-life care to Francophone and/or Allophone older adults across different care models and diverse geographies in Ontario will be collected through semi-structured interviews. Reflexive thematic analysis will be used to report themes within the data and consider the influence of the social locations of the researcher and research participants, geographic considerations impacting service provision, and barriers imposed by differing primary care funding structures on the provision of palliative and end-of-life care for linguistic and cultural minority groups in Ontario. Findings from this study will identify the interconnections among language and cultural discordance, care model, geographic region, and physician perceptions of their combined effects on access to, and quality of, palliative and end-of-life care. This evidence will be key to informing clinical practice guidelines and mobilizing change to improve primary care access and quality for adults at the end-of-life from linguistic and cultural minority populations across Ontario. [ABSTRACT FROM AUTHOR]

Background: Private healthcare in South Africa is largely financed by medical schemes. Optometrists reluctantly contract with administrators and networks to service these patients, despite them feeling networks are undesirable and exploitative. Networks contend that various mechanisms employed are necessary to ensure sustainability and prevent fraud, wastage and abuse. A working relationship between practitioners and networks should ideally be cordial and appreciated by each party as being mutually beneficial to the success of their respective businesses. Aim: To assess practitioners' knowledge and perceptions regarding optometric networks. Setting: The study was conducted amongst optometric professionals in the private sector in South Africa. Methods: A descriptive, mixed-method study was conducted using a semi-structured questionnaire. Interviews with senior personnel from the networks were conducted. Results: Approximately 77% of respondents belonged to networks with 91% being knowledgeable about networks and their role within optometry. Opticlear had 72% members, while Iso Leso and preferred provider negotiators (PPN) had 67% and 41%, respectively. Most optometrists (69%) neither believed in the need for networks nor that they provide value to the profession, while 94.7% joined networks merely to receive direct payment and access patients, with no other benefits noted. Conclusion: Practitioners reluctantly contract to networks for direct payment and to access patients. Furthermore, practitioners feel that networks bully and victimise them while networks highlight their responsibility to reduce healthcare costs and negative practices of fraud, waste and abuse. Contribution: Providing sustainable, cost-effective and quality eye care services requires collaboration between networks and practitioners and appreciating each other's roles in the delivery of eye care services. [ABSTRACT FROM AUTHOR]