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Contact Lens & Anterior Eye : the... Oct 2023In light of the increased roles of optometrists working in primary care in the UK, this research study aimed to gain an insight into perceptions of dry eye disease...
PURPOSE
In light of the increased roles of optometrists working in primary care in the UK, this research study aimed to gain an insight into perceptions of dry eye disease (DED), knowledge and confidence in diagnosis and management, and satisfaction with currently available treatment options.
METHODS
Links to an online survey were distributed to optometrists across the UK via optometry websites newsletters, conferences, and local optical committee data bases, between October 2021 and July 2022. The anonymous questionnaire contained a variety of question types including multiple choice, likert-type scale, and free text questions.
RESULTS
The survey was completed by 131 optometrists, with a broad range of experience, who reported examining 33.3 ± 31.0 dry eye patients per month. Forty-eight percent of respondents were involved in the provision of an extended service. Fluorescein tear breakup time, corneal fluorescein staining, and anterior lid assessment were the most used clinical procedures, both for diagnosis and monitoring purposes. Sixty percent of respondents reported that they believed their patients were satisfied/managed with artificial tear alone, with the availability of a preservative free option being the top consideration, particularly with increasing severity. Of the 18.7% of respondents who held Independent prescriber status, 68% felt this had widened their ability to diagnose and treat DED. This was evidenced by an increase in steroid recommendation for moderate and severe disease.
CONCLUSIONS
Although dry eye disease was perceived to be an important condition, opinions varied widely regarding knowledge and confidence in diagnosis and management. Involvement in an extended service did not alter patient management. However, an increase in therapeutic management and the employment of a stepwise approach to management has been identified.
Topics: Humans; Optometrists; Practice Patterns, Physicians'; Dry Eye Syndromes; Fluorescein; United Kingdom
PubMed: 37455178
DOI: 10.1016/j.clae.2023.101889 -
Seminars in Hearing Nov 2019As of September 10, 2019, there were 75 medications (oral/injectable/inhalants) approved by the U.S. Food and Drug Administration for diabetes management: 1 inhalant, 21... (Review)
Review
As of September 10, 2019, there were 75 medications (oral/injectable/inhalants) approved by the U.S. Food and Drug Administration for diabetes management: 1 inhalant, 21 oral combinations, 22 injectable, and 31 oral medications (not in combination with any other diabetes drug). This article isolates the auditory and vestibular side effects of those drugs as reported by the drug's manufacturer as well as those side effects that could interfere with a balance assessment. Twenty of the 75 approved medications (26%) could have an auditory-related side effect. Hearing loss and tinnitus are not on the list. Only two, or just 3%, have vertigo and spinning as reported side effects (one each). More than 50% of the drugs will have some effect on a balance assessment. Audiologists who evaluate a patient with diabetes (PWD) are presented with symptoms that be related to their diabetes medication. Although the manufacturer might report a side effect as rare or as a percentage from their clinical trials subjects, not all PWD will experience these adverse events. Auditory and vestibular side effects do not dominate the diabetes drug side effect list, but, rather, the most reported side effects could impact a balance assessment. The lists that appear in Appendices A and B should serve as a guide for all professionals involved in managing the PWD (i.e., audiologists, otolaryngologists, diabetes educators, pharmacists, optometrists, dentists, etc.). The list also serves as a counseling tool if a communication problem emerges during the progression of the diabetes.
PubMed: 31602095
DOI: 10.1055/s-0039-1697645 -
Indian Journal of Ophthalmology Jul 2020Artificial intelligence (AI) in healthcare is the use of computer-algorithms in analyzing complex medical data to detect associations and provide diagnostic support... (Review)
Review
Artificial intelligence (AI) in healthcare is the use of computer-algorithms in analyzing complex medical data to detect associations and provide diagnostic support outputs. AI and deep learning (DL) find obvious applications in fields like ophthalmology wherein huge amount of image-based data need to be analyzed; however, the outcomes related to image recognition are reasonably well-defined. AI and DL have found important roles in ophthalmology in early screening and detection of conditions such as diabetic retinopathy (DR), age-related macular degeneration (ARMD), retinopathy of prematurity (ROP), glaucoma, and other ocular disorders, being successful inroads as far as early screening and diagnosis are concerned and appear promising with advantages of high-screening accuracy, consistency, and scalability. AI algorithms need equally skilled manpower, trained optometrists/ophthalmologists (annotators) to provide accurate ground truth for training the images. The basis of diagnoses made by AI algorithms is mechanical, and some amount of human intervention is necessary for further interpretations. This review was conducted after tracing the history of AI in ophthalmology across multiple research databases and aims to summarise the journey of AI in ophthalmology so far, making a close observation of most of the crucial studies conducted. This article further aims to highlight the potential impact of AI in ophthalmology, the pitfalls, and how to optimally use it to the maximum benefits of the ophthalmologists, the healthcare systems and the patients, alike.
Topics: Algorithms; Artificial Intelligence; Diabetic Retinopathy; Glaucoma; Humans; Infant, Newborn; Ophthalmology
PubMed: 32587159
DOI: 10.4103/ijo.IJO_1754_19 -
Hypertension (Dallas, Tex. : 1979) Jan 2021In this review of the literature and commentary, we examine the literature on automated blood pressure (BP) measurements in the office and clinic. Our purpose is to... (Review)
Review
In this review of the literature and commentary, we examine the literature on automated blood pressure (BP) measurements in the office and clinic. Our purpose is to revisit issues as to the pros and cons of automated BP measurement published in in June 2020 and to identify areas needing additional research. Despite initial reservations about automated BP, it is here to stay. A number of experts suggest that human error will be reduced when we move from the more complex skills required by aneroid sphygmomanometer measurement to the fewer skills and steps required by automated BP measurement. Our review indicates there is still need for reduction in errors in automated BP assessment, for example, retraining programs and monitoring of assessment procedures. We need more research on the following questions: (1) which classes of health care providers are least likely to measure BP accurately, usually by ignoring necessary steps; (2) how accurate is BP assessment by affiliated health care providers for example the dental office, the optometrist; and (3) why do some dedicated and well-informed health care professionals fail to follow simple directions for automated BP measurement? We offer additional solutions for improving automated BP assessment in the office and clinic.
Topics: Automation; Blood Pressure Determination; Diagnostic Errors; Health Personnel; Humans
PubMed: 33296246
DOI: 10.1161/HYPERTENSIONAHA.120.16164 -
Frontiers in Human Neuroscience 2022Visual disturbances are amongst the most commonly reported symptoms after a traumatic brain injury (TBI) despite vision testing being uncommon at initial clinical... (Review)
Review
Visual disturbances are amongst the most commonly reported symptoms after a traumatic brain injury (TBI) despite vision testing being uncommon at initial clinical evaluation. TBI patients consistently present a wide range of visual complaints, including photophobia, double vision, blurred vision, and loss of vision which can detrimentally affect reading abilities, postural balance, and mobility. In most cases, especially in rural areas, visual disturbances of TBI would have to be diagnosed and assessed by primary care physicians, who lack the specialized training of optometry. Given that TBI patients have a restricted set of visual concerns, an opportunity exists to develop a screening protocol for specialized evaluation by optometrists-one that a primary care physician could comfortably carry out and do so in a short time. Here, we designed a quick screening protocol that assesses the presence of core visual symptoms present post-TBI. The MOBIVIS (Montreal Brain Injury Vision Screening) protocol takes on average 5 min to perform and is composed of only "high-yield" tests that could be performed in the context of a primary care practice and questions most likely to reveal symptoms needing further vision care management. The composition of our proposed protocol and questionnaire are explained and discussed in light of existing protocols. Its potential impact and ability to shape a better collaboration and an integrative approach in the management of mild TBI (mTBI) patients is also discussed.
PubMed: 35911590
DOI: 10.3389/fnhum.2022.858378 -
Ophthalmic & Physiological Optics : the... Sep 2023In the UK, ophthalmology has the highest number of outpatient appointments within the National Health Service. False-positive referrals from primary care are one of the... (Review)
Review
PURPOSE
In the UK, ophthalmology has the highest number of outpatient appointments within the National Health Service. False-positive referrals from primary care are one of the main factors contributing to the oversubscription of hospital eye services (HESs). We reviewed the accuracy of referrals originating from primary care optometrists and contributing factors, such as condition type and years since registration.
RECENT FINDINGS
Of the 31 studies included in the review, 22 were retrospective analyses of referrals and appointments at the HES. Eight were prospective studies, and one used online clinical vignettes. Seven assessed the accuracy of referrals for all ocular conditions. The remaining studies focused on glaucoma (n = 11), cataracts (n = 7), emergency conditions (n = 4), neovascular age-related macular degeneration (n = 1) and paediatric binocular vision (n = 1). The diagnostic agreement for suspected emergency ocular conditions was the lowest, with only 21.1% of referrals considered to require urgent attention in one study. For glaucoma, the first-visit discharge rate was high (16.7%-48%). Optometrist referral accuracy was overall 18.6% higher than General Medical Practitioners'; however, the two mainly referred different ocular conditions. Female optometrists made more false-positive referrals than males (p = 0.008). The proportion of false positives decreased by 6.2% per year since registration (p < 0.001).
SUMMARY
There was significant variation in referral accuracy across different ocular conditions, partly due to differences when defining accurate referrals. Optometrists working in primary care are generally more limited in their resources than the HES. Thus, choosing the cautious option of referral when they are unsure could be in the patients' best interests. The possible effect of increased use of advanced imaging on referrals requires evaluation. Although interventions such as refinement schemes have been put in place, these vary across regions, and their approaches such as virtual referral triaging may reduce unnecessary HES face-to-face appointments and promote communication between primary and secondary care.
Topics: Male; Humans; Female; Child; Optometrists; Optometry; Retrospective Studies; Prospective Studies; State Medicine; Glaucoma; Referral and Consultation
PubMed: 37395045
DOI: 10.1111/opo.13183 -
Cureus May 2023Purpose The purpose of this study is to investigate musculoskeletal pain among eye care professionals. Methods This cross-sectional study was conducted using an...
Purpose The purpose of this study is to investigate musculoskeletal pain among eye care professionals. Methods This cross-sectional study was conducted using an electronic detailed questionnaire through Google Forms. The structured questionnaire was distributed through various social media platforms targeting eye care professionals. The study included currently practicing ophthalmologists (Consultants, Specialists, Residents), optometrists, and orthoptists. Results A total of 514 eye care professionals participated in the study. The majority were younger than 30 years old (43.8%), with more than half being males (51.8%) and ophthalmologists (55.2%). The prevalence of eye care professionals who were suffering from musculoskeletal pain was 66.7%. The prevalence was significantly higher among females (76.2%) and those over 50 years old (71.4%). Sixty-eight point three percent (68.3%) of participants who don't do running exercises and 92.2% of those with comorbidities suffer from pain. The prevalence of pain among eye care professionals who every week examine more than 150 patients is 72.4%, perform more than 20 surgeries is 85.7%, and conduct more than 20 laser treatment sessions is 100%. Conclusion Musculoskeletal pain is highly prevalent among eye care professionals. This is especially true among females and older adults (>50 years). Among different exercises, running is most protective against musculoskeletal pain. Comorbidities contribute significantly to developing pain.
PubMed: 37362510
DOI: 10.7759/cureus.39403 -
Journal of Cataract and Refractive... Jul 2023A 62-year-old woman with mild myopia presented to her local optometrist for a routine examination and was found to have intraocular pressure (IOP) of 30 mm Hg in both...
A 62-year-old woman with mild myopia presented to her local optometrist for a routine examination and was found to have intraocular pressure (IOP) of 30 mm Hg in both eyes and cupped nerves. She had a family history of glaucoma in her father. She was started on latanoprost in both eyes and was referred for a glaucoma evaluation. On initial evaluation, her IOP was 25 mm Hg in the right eye and 26 mm Hg in the left eye. Central corneal thickness measured 592 µm in the right eye and 581 µm in the left eye. Her angles were open to gonioscopy without any peripheral anterior synechia. She had 1+ nuclear sclerosis with a corrected distance visual acuity (CDVA) of 20/25 in the right eye and 20/30- in the left eye and uncorrected near visual acuity of J1+ in each eye. Her nerves were 0.85 mm in the right eye and 0.75 mm in the left eye. Optical coherence tomography (OCT) showed retinal nerve fiber layer thinning and a dense superior arcuate scotoma into fixation in her right eye, and superior and inferior arcuate scotomas in her left eye (Figures 1 and 2JOURNAL/jcrs/04.03/02158034-202307000-00019/figure1/v/2023-06-26T195222Z/r/image-tiffJOURNAL/jcrs/04.03/02158034-202307000-00019/figure2/v/2023-06-26T195222Z/r/image-tiff, Supplemental Figures 1 and 2, available at http://links.lww.com/JRS/A882 and http://links.lww.com/JRS/A883). She was successively trialed on fixed combination brimonidine-timolol, dorzolamide, and netarsudil, in addition to her latanoprost, but her IOP remained in the mid- to upper 20s in both eyes. The addition of acetazolamide lowered the pressure to 19 mm Hg in both eyes, but she tolerated it poorly. Methazolamide was also attempted with similar side effects. We elected to perform left eye cataract surgery combined with 360-degree viscocanaloplasty and insertion of a Hydrus microstent (Alcon Laboratories, Inc.). Surgery was uncomplicated with IOP of 16 mm Hg on postoperative day 1 with no glaucoma medications. However, by postoperative week 3, IOP returned to 27 mm Hg, and despite restarting latanoprost-netarsudil and finishing her steroid taper, IOP remained at 27 mm Hg by postoperative week 6. Brimonidine-timolol was added back to her left eye regimen and at postoperative week 8, IOP had elevated to 45 mm Hg. Maximizing her therapy with the addition of topical dorzolamide and oral methazolamide brought her IOP back down to 30 mm Hg. At that point, the decision was made to proceed with trabeculectomy of the left eye. The trabeculectomy was uneventful. However, postoperative attempts to augment filtration were rendered less successful by extremely thick Tenon layer. At her most recent follow-up the pressure in the left eye was mid-teens with brimonidine-timolol and dorzolamide. Her right eye IOP is in the upper 20s on maximum topical therapy. Knowing her postoperative course in the left eye, how would you manage the right eye? In addition to currently available options, would you consider a supraciliary shunt such as the MINIject (iSTAR) if such a device were U.S. Food and Drug Administration (FDA)-approved?
Topics: Humans; United States; Female; Adolescent; Middle Aged; Glaucoma, Open-Angle; Latanoprost; Methazolamide; Timolol; Glaucoma; Treatment Outcome
PubMed: 37390324
DOI: 10.1097/j.jcrs.0000000000001221 -
American Journal of Ophthalmology Case... Mar 2022This case report describes the therapeutic management of a 61-year-old male who experienced aquarium coral keratoconjunctivitis caused by exposure to palytoxin and...
PURPOSE
This case report describes the therapeutic management of a 61-year-old male who experienced aquarium coral keratoconjunctivitis caused by exposure to palytoxin and provides an additional resource to raise awareness and treat patients with ocular exposure to palytoxin.
OBSERVATIONS
A 61-year-old male inadvertently touched his left eye while cleaning an aquarium. Within 24 hours, pain, redness and visual blurring was noted. After 48 hours his best corrected visual acuity was measured at 20/25 on the right eye and 20/200 on the left. A thick mucopurulent discharge was present with associated conjunctival edema. The corneal epithelium was denuded centrally and inferiorly with subepithelial infiltrates peripherally. The patient was treated with topical moxifloxacin (0.5%) drops 6x/day and prednisolone acetate (1%) 4x/day. He was seen for follow up 48 hours later with a significant improvement in discomfort. Vision had improved to 20/60 with resolution of conjunctival edema, partial corneal epithelialization and reduced erythema. Cultures for culture and sensitivity returned as normal. The patient's steroid regime was gradually tapered during reassessments at four and ten days by which time the left eye acuity had returned to 20/25 with no symptoms. Therapy was discontinued with the exception of artificial tears. The patient continued to do well at his 42-day follow-up appointment with persistent corneal epithelialization, absence of infiltrates and a stable visual acuity of 20/25 in the affected eye. His local optometrist confirmed that the acuity was consistent with measurements obtained prior to the insult.
CONCLUSIONS
The combination of moxifloxacin eye drops and prednisolone acetate eye drops were effective in treating the patient's aquarium coral keratoconjunctivitis as after being treated the patient regained his baseline visual acuity in the affected eye (best corrected visual acuity of 20/25).
IMPORTANCE
Currently, there are only a handful of case-reports published on ocular exposure to palytoxin. This case report will add to the literature by providing an additional resource for health care providers, in the treatment of patients with ocular exposure to palytoxin and increasing awareness to this rare condition.
PubMed: 35128163
DOI: 10.1016/j.ajoc.2022.101326 -
Clinical & Experimental Optometry May 2022Conjunctivitis, chalazion and blepharitis are routinely managed by optometrists. However, it is especially important to consider the diagnosis of canaliculitis in...
CLINICAL RELEVANCE
Conjunctivitis, chalazion and blepharitis are routinely managed by optometrists. However, it is especially important to consider the diagnosis of canaliculitis in patients with chronic or recurrent conditions.
BACKGROUND
This study aimed to report the clinical features, radiological findings and treatment outcomes in patients with plug-related canaliculitis.
METHODS
This retrospective study included patients with canaliculitis secondary to plug insertion between 2007 and 2020. All data regarding epidemiological characteristics, clinical presentation, isolated microorganisms, computed tomography imaging findings, treatment, and outcomes were analysed.
RESULTS
A total of 20 plug-related canaliculitis from 19 patients (18.3%) among all 109 cases of canaliculitis were identified. All patients with plug-related canaliculitis were females with a past history of lacrimal plug insertion for dry eye (mean age: 58.2 years). Most patients were initially treated as conjunctivitis with the mean time lapse to a diagnosis of 5.2 months. The average time from plug insertion to onset of symptoms was 5.1 years. Eighteen patients underwent canaliculotomy, and one patient received lacrimal irrigation. Plugs were identified in 18 cases, with SmartPlug in 13 cases (72%), followed by EaglePlugTM (two cases), Herrick Lacrimal Plug (two cases), and migrated FCI Painless Plug (1 case). Cultures of discharge, concretions, and/or infected plugs mostly revealed Pseudomonas aeruginosa (42%). Orbital computed tomography in four cases with SmartPlug revealed central radiolucency with surrounding soft-tissue enhancement. No recurrent canaliculitis was observed throughout a mean follow-up period of 13.7 months. No patient needed re-plugging after canaliculotomy and plug removal, with only one required additional lubricants for recurrent dry eye.
CONCLUSION
Plug-related canaliculitis is often underdiagnosed due to late onset and similar symptoms to common ocular diseases. Awareness of plug insertion history as well as meticulous removal of the plug, concretion and/or granulation tissue is important for early diagnosis and to ensure a good outcome.
Topics: Canaliculitis; Conjunctivitis; Dry Eye Syndromes; Female; Humans; Lacrimal Apparatus; Male; Middle Aged; Retrospective Studies
PubMed: 34139956
DOI: 10.1080/08164622.2021.1927675