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Eye and Brain 2021To assess the diagnostic accuracy of visual field results generated by the newly developed software (CU-VF) and the standard automated perimetry (SAP) for detecting...
PURPOSE
To assess the diagnostic accuracy of visual field results generated by the newly developed software (CU-VF) and the standard automated perimetry (SAP) for detecting hemianopia.
PATIENTS AND METHODS
Forty-three subjects with hemianopia and 33 controls were tested with the CU-VF software on a personal computer and SAP. Hemianopia was defined as the presence of a hemianopic field respecting the vertical meridian on SAP with the corresponding neuroimaging pathology as evaluated by 2 neuro-ophthalmologists. Results of CU-VF were independently evaluated by 2 neuro-ophthalmologists, 1 general ophthalmologist, and 1 general practitioner in terms of the presence of hemianopia. Sensitivity, specificity, and kappa coefficient for inter-observer reliability were calculated. Satisfaction and ease of use were evaluated with a visual analog-scale questionnaire and analyzed using paired -test.
RESULTS
The sensitivity (95% CI) and specificity (95% CI) of the CU-VF to detect hemianopia was 74.42% (58.53-85.96) and 93.94% (78.38-99.94). Kappa coefficient between neuro-ophthalmologists versus general ophthalmologist and general practitioner were 0.71 and 0.84, respectively. The mean (SD) test duration was 2.25 (0.002) minutes for the CU-VF and 5.38 (1.34) minutes for SAP (p < 0.001). Subjects reported significantly higher satisfaction and comfort using the CU-VF software compared to SAP.
CONCLUSION
The CU-VF screening software showed good validity and reliability to detect hemianopia, with shorter test duration and higher subject satisfaction compared to SAP.
PubMed: 34512063
DOI: 10.2147/EB.S315403 -
JAMA Ophthalmology Jan 2018As the United States considers how to best structure its health care services, specialty care availability is receiving increased focus. This study assesses whether...
IMPORTANCE
As the United States considers how to best structure its health care services, specialty care availability is receiving increased focus. This study assesses whether patients lack reasonable access to ophthalmologists in states where optometrists have been granted expanded scope of practice.
OBJECTIVE
To determine the estimated travel time (ETT) to the nearest ophthalmologist office for persons residing in states that have expanded scope of practice for optometrists, and to quantify ETT to the nearest ophthalmologist for Medicare beneficiaries who received surgical care from optometrists in those states between 2008 and 2014.
DESIGN, SETTING, AND PARTICIPANTS
This study used data from the 2010 US census, a 2016 American Academy of Ophthalmology member database, and a data set of claims data for a random sample of 20% of beneficiaries enrolled in Medicare nationwide from 2008 to 2014 (n=14 063 725). Combining these sources with geographic information systems analysis, the ETT to the nearest ophthalmologist office was calculated for every resident of Kentucky, Oklahoma, and New Mexico. This study also assessed ETT to the nearest ophthalmologist for Medicare beneficiaries in those states who had received surgery from an optometrist from 2008 to 2014. Data analyses were conducted from July 2016 to July 2017.
MAIN OUTCOMES AND MEASURES
The proportion of residents of Kentucky, Oklahoma, and New Mexico who live within an ETT of 10, 30, 45, 60, or 90 minutes of the nearest ophthalmologist office.
RESULTS
The study included 4 339 367 Kentucky residents, 3 751 351 Oklahoma residents, and 2 059 179 New Mexico residents. Of these, 5 140 547 (50.6%) were female. Racial/ethnic composition included 7 154 847 people (70.5%) who were white, 640 608 (6.3%) who were black, and 1 418 246 (14.0%) who were Hispanic. The mean (SD) age was 37.8 (22.8) years. More than 75% of residents in the 3 states lived within an ETT of 30 minutes to the nearest ophthalmology office, and 94% to 99% of residents lived within an ETT of 60 minutes to the nearest ophthalmology office. Among Medicare beneficiaries who received surgery by optometrists, 58.3%, 51.1%, and 46.9% in Kentucky, Oklahoma, and New Mexico, respectively, lived within an ETT of 30 minutes from the nearest ophthalmologist office.
CONCLUSIONS AND RELEVANCE
In the states where optometrists have expanded scope of practice, most residents lived within an ETT of 30 minutes of the nearest ophthalmologist office, as do half of Medicare beneficiaries who received surgical care from optometrists. These results can help inform policy makers when weighing the pros and cons of scope of practice expansion for optometrists.
Topics: Female; Health Services Accessibility; Humans; Male; Ophthalmologists; Optometrists; Patient Care Team; Population Surveillance; Practice Patterns, Physicians'; Retrospective Studies; Time Factors; Travel; United States
PubMed: 29167903
DOI: 10.1001/jamaophthalmol.2017.5081 -
Lupus Science & Medicine Nov 2020Hydroxychloroquine (HCQ) retinal toxicity is an ongoing concern for rheumatologists. The revised 2016 American Academy of Ophthalmology (AAO) guidelines created...
OBJECTIVE
Hydroxychloroquine (HCQ) retinal toxicity is an ongoing concern for rheumatologists. The revised 2016 American Academy of Ophthalmology (AAO) guidelines created controversy regarding the correct dosing and evaluation of HCQ toxicity. The current study was initiated to further understand rheumatologists' practices regarding HCQ.
METHODS
A questionnaire-based survey was distributed electronically to rheumatologists. We collected information on HCQ dosing, clinical decision-making processes, familiarity with the AAO 2016 guidelines, and perceived disparities between the AAO 2016 guidelines and rheumatological clinical practice.
RESULTS
78 rheumatologists completed the survey (49% from USA, 90% academic practices, 82% self-identified as lupus experts). Only lupus expert (n=64) data were included in subsequent analysis. The mean cohort size was 747 (50-6571), a total cohort 45 612 patients. HCQ was prescribed to >75% of patients with SLE by 81.3% of SLE experts, with routine counselling about ophthalmic risks. The typical dose of HCQ used was 200-400 mg/day. 17% of rheumatologists use doses up to 600 mg/day, while 6.2% use up to 6.5 mg/kg/day. HCQ adherence is routinely assessed. 479 cases of HCQ retinal toxicity (1.05%) and 9 cases of HCQ-associated blindness (1.8 per 10 000 patients) were reported. 89.1% of respondents reported familiarity with the AAO guidelines. Those aware of the guidelines cited limited dosing options (54.7%), lack of supporting evidence (57.8%) and low patient adherence (43.8%) as obstacles to greater implementation of the guidelines.
CONCLUSION
These data suggest that HCQ toxicity and blindness are rare in patients with SLE. Rheumatologists treating patients with SLE are aware of the guidelines and appreciate the importance of partnering with ophthalmologists in preventing retinal toxicity.
Topics: Adult; Antirheumatic Agents; Cohort Studies; Female; Humans; Hydroxychloroquine; Ophthalmologists; Rheumatologists; United States
PubMed: 33148665
DOI: 10.1136/lupus-2020-000427 -
Indian Journal of Ophthalmology Nov 2021The burden of diabetes mellitus (DM) and diabetic retinopathy (DR) is at alarming proportions in India and around the globe. The number of people with DM in India is...
The burden of diabetes mellitus (DM) and diabetic retinopathy (DR) is at alarming proportions in India and around the globe. The number of people with DM in India is estimated to increase to over 134 million by 2045. Screening and early identification of sight-threatening DR are proven ways of reducing DR-related blindness. An ideal DR screening model should include personalized awareness, targeted screening, integrated follow-up reminders, and capacity building. The DR screening technology is slowly shifting from direct examination by an ophthalmologist to remote screening using retinal photographs, including telescreening and automated grading of retinal images using artificial intelligence. The ophthalmologist-to-patient ratio is poor in India, and there is an urban-rural divide. The possibility of screening all people with diabetes by ophthalmologists alone is a remote possibility. It is prudent to use the available nonophthalmologist workforce for DR screening in tandem with the technological advances. Capacity-building efforts are based on the principle of task sharing, which allows for the training of a variety of nonophthalmologists in DR screening techniques and technology. The nonophthalmologist human resources for health include physicians, optometrists, allied ophthalmic personnel, nurses, and pharmacists, among others. A concurrent augmentation of health infrastructure, conducive health policy, improved advocacy, and increased people's participation are necessary requirements for successful DR screening. This perspective looks at the characteristics of various nonophthalmologist DR screening models and their applicability in addressing DR-related blindness in India.
Topics: Artificial Intelligence; Diabetes Mellitus; Diabetic Retinopathy; Humans; Mass Screening; Ophthalmologists; Optometrists
PubMed: 34708745
DOI: 10.4103/ijo.IJO_1117_21 -
Journal of Diabetes Investigation Jul 2023Regular screening for diabetic retinopathy is essential. This study aimed to show the process and current situation of diabetic retinopathy screening prescribed by...
Patient referral flow between physician and ophthalmologist visits for diabetic retinopathy screening among Japanese patients with diabetes: A retrospective cross-sectional cohort study using the National Database.
AIMS/INTRODUCTION
Regular screening for diabetic retinopathy is essential. This study aimed to show the process and current situation of diabetic retinopathy screening prescribed by physicians (internists) and ophthalmologists for Japanese patients with diabetes.
MATERIALS AND METHODS
This retrospective cohort study used data from the Japanese National Database of Insurance Claims between April 2016 and March 2018. Ophthalmology visits and fundus examinations are defined using specific medical procedure codes. The proportion of ophthalmology visits for patients with diabetic medication and for fundus examination among those who visited ophthalmologists was calculated in the fiscal year 2017. A modified Poisson regression analysis was carried out to identify factors associated with retinopathy screening. Similarly, quality indicators by prefectures were also calculated.
RESULTS
Among 4,408,585 patients receiving diabetic medications (57.8% men, 14.1% insulin use), 47.4% visited the ophthalmology department and 96.9% of those underwent fundus examination. Regression analysis showed that female sex, older age, insulin use, medical facilities with Japan Diabetes Society certification and large medical facilities were predictors of fundus examination. By prefecture, the ophthalmology consultation rate and the fundus examination ranged 38.5-51.0% and 92.1-98.7%, respectively.
CONCLUSIONS
Less than half of the patients who were prescribed antidiabetic medication by their physicians visited an ophthalmologist. However, most of the patients who visited an ophthalmologist had a fundus examination carried out. A similar tendency was noted for each prefecture. It is essential to reaffirm the necessity of recommending ophthalmologic examinations to physicians and healthcare professionals who care for patients with diabetes.
Topics: Female; Humans; Male; Cross-Sectional Studies; Diabetes Mellitus; Diabetic Retinopathy; East Asian People; Insulins; Mass Screening; Ophthalmologists; Physicians; Referral and Consultation; Retrospective Studies
PubMed: 37132068
DOI: 10.1111/jdi.14018 -
Indian Journal of Ophthalmology May 2020
Topics: Betacoronavirus; COVID-19; Conjunctivitis; Coronavirus; Coronavirus Infections; Humans; Ophthalmologists; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32317428
DOI: 10.4103/ijo.IJO_869_20 -
American Journal of Ophthalmology Dec 2020
Topics: COVID-19; Humans; Internship and Residency; Ophthalmologists; Ophthalmology; Pandemics; Physical Distancing; SARS-CoV-2; Stress, Psychological
PubMed: 32971023
DOI: 10.1016/j.ajo.2020.06.048 -
Eye (London, England) Jul 2020We aimed to estimate the supply of ophthalmologists in relation to the global and regional burden of vision-threatening diabetic retinopathy (VTDR). Diabetes mellitus... (Meta-Analysis)
Meta-Analysis Review
We aimed to estimate the supply of ophthalmologists in relation to the global and regional burden of vision-threatening diabetic retinopathy (VTDR). Diabetes mellitus (DM) population data from seven world regions were obtained from the International Diabetes Federation Atlas 2017. A systematic review was performed to include population-, community-based studies that reported country-specific VTDR prevalence. Random effect meta-analysis was then performed to estimate global and regional VTDR prevalence. VTDR prevalence estimates coupled with DM population data were then used to estimate the number of VTDR cases. Global and regional number of ophthalmologists were derived from the International Council of Ophthalmology Report 2015. Fifty studies (17 from Western Pacific [WP], nine North America and Caribbean [NAC], nine Middle East and North Africa [MENA], five Europe, eight South East Asia [SEA], one South and Central America [SACA] and one from Africa) were included. Global VTDR prevalence was 7.26% (95% CI, 6.18-8.32%). Regional VTDR prevalence was 14.35% in Africa, 11.21% in MENA, 10.00% in NAC, 6.32% in Europe, 6.22% in WP, 5.83% in SACA and 2.97% in SEA. Globally, there were 7.16 ophthalmologists per 1000 VTDR patients. Europe had the highest ophthalmologist per 1000 VTDR patient ratio at 18.03 followed by SACA (17.41), while NAC, MENA and Africa had the lowest at 4.90, 4.81 and 0.91 respectively. Across regions, the ophthalmologist densities ranged from 0.91 to 18.03 per 1000 VTDR patients, with NAC, MENA and Africa having less than 5 ophthalmologists per 1000 patients. These findings will aid global and regional policy planning and healthcare resource allocation for VTDR management.
Topics: Africa; Diabetes Mellitus; Diabetic Retinopathy; Ethnicity; Humans; Ophthalmologists; Prevalence
PubMed: 31992863
DOI: 10.1038/s41433-020-0776-5 -
Clinics in Dermatology 2020
Topics: Betacoronavirus; COVID-19; Conjunctivitis, Viral; Coronavirus Infections; Humans; Ophthalmologists; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32972612
DOI: 10.1016/j.clindermatol.2020.03.013 -
American Journal of Ophthalmology Dec 2020
Topics: COVID-19; Humans; Ophthalmologists; Pandemics; Patient Advocacy; SARS-CoV-2
PubMed: 32961114
DOI: 10.1016/j.ajo.2020.07.016