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Clinical & Experimental Optometry Sep 2021A gap exists between best evidence and actual clinical care provided to patients. The advent of evidence-based practice was meant to address this gap by providing... (Review)
Review
A gap exists between best evidence and actual clinical care provided to patients. The advent of evidence-based practice was meant to address this gap by providing practitioners with a method to search, evaluate and incorporate evidence into practice. However, the gap continues to exist. The health research fields of and have evolved over the last few decades to assist practitioners in embedding research findings and best evidence into routine practice. Knowledge translation seeks to improve public health outcomes by facilitating the movement of best evidence from the bench to clinical practice. Implementation science is the study of methods to integrate research findings and evidence-based practice into routine practice. This literature review aims to revisit the concepts of evidence-based practice and to introduce knowledge translation and implementation science by exploring their roles and influences in the delivery of appropriate glaucoma care by optometrists.
Topics: Evidence-Based Practice; Humans; Implementation Science; Optometrists; Surveys and Questionnaires; Translational Research, Biomedical
PubMed: 33831335
DOI: 10.1080/08164622.2021.1898275 -
Clinical Optometry 2020To determine the current scope of practice with regards to cycloplegic examinations, specifically in the pediatric population. (Review)
Review
PURPOSE
To determine the current scope of practice with regards to cycloplegic examinations, specifically in the pediatric population.
METHODS
A comprehensive literature review was conducted using PubMed, ScienceDirect, Elsevier, and Google Scholar databases using keywords such as "cyclopentolate"; "tropicamide"; "pediatric"; "cycloplegia"; "atropine"; and "cycloplegic" from inception to October 2019.
RESULTS
Atropine has the strongest cycloplegic effect and is recommended for cases of large accommodative esotropia. Because of the undesired side effects and risks from atropine, cyclopentolate has been found to offer a very effective cycloplegia even for moderate to high hyperopia and has become the standard of care for traditional pediatric cycloplegic exams. Tropicamide has also been shown to offer adequate cycloplegia with less toxicity and side effects. Of all agents, tropicamide presents the least side effects and toxicity, whereas atropine presents the greatest. Cyclopentolate is a very safe cycloplegic agent that has risk of toxicity which increases with higher doses and concentrations.
CONCLUSION
The American Optometric Association's current pediatric cycloplegic guidelines have proven both safe and effective, as they recommend a conservative approach of using cyclopentolate 0.5% in infants and cyclopentolate 1% in those older than one-year old to avoid undesired side effects. Topical ophthalmic drops and spray instillation have both proved equally efficacious and therefore each have their place within a clinical setting. Using Cycolmydril under six months old and cyclopentolate 1% over 6 months old as recommended by the AAO, also provides a safe and effective guideline for cycloplegic examinations within the pediatric population.
PubMed: 32904515
DOI: 10.2147/OPTO.S217645 -
Clinical Optometry 2017Infantile nystagmus (IN), previously known as congenital nystagmus, is an involuntary to-and-fro movement of the eyes that persists throughout life. IN is one of three... (Review)
Review
Infantile nystagmus (IN), previously known as congenital nystagmus, is an involuntary to-and-fro movement of the eyes that persists throughout life. IN is one of three types of early-onset nystagmus that begin in infancy, alongside fusion maldevelopment nystagmus syndrome and spasmus nutans syndrome. Optometrists may also encounter patients with acquired nystagmus. The features of IN overlap largely with those of fusion maldevelopment nystagmus syndrome, spasmus nutans syndrome, and acquired nystagmus, yet the management for each subtype is different. Therefore, the optometrist's role is to accurately discern IN from other forms of nystagmus and to manage accordingly. As IN is a lifelong condition, its presence not only affects the visual function of the individual but also their quality of life, both socially and psychologically. In this report, we focus on the approaches that involve optometrists in the investigation and management of patients with IN. Management includes the prescription of optical treatments, low-vision rehabilitation, and other interventions such as encouraging the use of the null zone and referral to support groups. Other treatments available via ophthalmologists are also briefly discussed in the article.
PubMed: 30214368
DOI: 10.2147/OPTO.S126214 -
Clinical & Experimental Optometry Mar 2022Healthcare in the twenty-first century has witnessed an increased use of prescription drugs. As a member of a patient's health care team, optometrists should be aware of... (Review)
Review
Healthcare in the twenty-first century has witnessed an increased use of prescription drugs. As a member of a patient's health care team, optometrists should be aware of the pharmaceuticals taken by patients and their potential ocular complications. This paper will discuss the most prescribed medications in Australia today and their effects on the visual system. The paper will review the agents used to treat six common systemic conditions, their frequency of use, mechanism of action, clinical indications, and potential ocular manifestations. Literature has documented both positive and negative associations of systemic medications on the eye's health. Many associations documented here have shown conflicting evidence, thus warranting further investigation. Based on the frequency and severity of the ocular manifestations in the literature, recommendations for clinical care are given. Being familiar with the most common ocular side effects associated with common systemic medications aids in the correct and timely diagnosis of ocular complications to prevent permanent sequelae.
Topics: Australia; Eye Diseases; Humans; Optometrists; Optometry; Pharmaceutical Preparations
PubMed: 34407728
DOI: 10.1080/08164622.2021.1945409 -
Clinical & Experimental Optometry May 2021This review presents the phenotypic and genotypic profiles of a select group of inherited retinal diseases (IRDs) that are currently the focus of retinal gene therapy... (Review)
Review
This review presents the phenotypic and genotypic profiles of a select group of inherited retinal diseases (IRDs) that are currently the focus of retinal gene therapy trials globally. Research progress in IRD treatment trials may soon lead to their availability in Australia and New Zealand, as either approved treatment or a clinical trial. The salient clinical characteristics of retinitis pigmentosa-the largest IRD category-are highlighted, with specific reference to -associated Leber congenital amaurosis, followed by other specific IRDs, namely choroideremia and -associated Stargardt disease. These IRDs are selected based on their candidacy for gene therapy. Guidance on the clinical diagnostic tests that support each of these diagnoses will be presented. More broadly, the most useful structure and function measures to monitor IRD progression is discussed, along with the key assessments that offer differential diagnostic insight. This review is intended to be a clinical guide for optometrists, to assist in assessment and management of individuals who may be eligible for current and future gene therapies. A companion article in this issue will provide an overview of the basic principles of gene therapy and its development as a new treatment for inherited retinal diseases.
Topics: ATP-Binding Cassette Transporters; Genetic Therapy; Humans; Leber Congenital Amaurosis; Optometrists; Retina; Retinal Diseases
PubMed: 33689629
DOI: 10.1080/08164622.2021.1878851 -
Journal of Optometry 2022The application of artificial intelligence (AI) in diagnosing and managing ocular disease has gained popularity as research highlights the utilization of AI to improve...
PURPOSE
The application of artificial intelligence (AI) in diagnosing and managing ocular disease has gained popularity as research highlights the utilization of AI to improve personalized medicine and healthcare outcomes. The objective of this study is to describe current optometric perspectives of AI in eye care.
METHODS
Members of the American Academy of Optometry were sent an electronic invitation to complete a 17-item survey. Survey items assessed perceived advantages and concerns regarding AI using a 5-point Likert scale ranging from "strongly agree" to "strongly disagree."
RESULTS
A total of 400 optometrists completed the survey. The mean number of years since optometry school completion was 25 ± 15.1. Most respondents reported familiarity with AI (66.8%). Though half of optometrists had concerns about the diagnostic accuracy of AI (53.0%), most believed it would improve the practice of optometry (72.0%). Optometrists reported their willingness to incorporate AI into practice increased from 53.3% before the COVID-19 pandemic to 65.5% after onset of the pandemic (p<0.001).
CONCLUSION
In this study, optometrists are optimistic about the use of AI in eye care, and willingness to incorporate AI in clinical practice also increased after the onset of the COVID-19 pandemic.
Topics: Humans; Optometrists; Artificial Intelligence; COVID-19; Pandemics; Optometry
PubMed: 36137899
DOI: 10.1016/j.optom.2022.06.006 -
Clinical & Experimental Optometry May 2021: Clinical optometric practice is underpinned by a rigorous research base, the primary evidence for which is publications in refereed scientific journals. Leading...
: Clinical optometric practice is underpinned by a rigorous research base, the primary evidence for which is publications in refereed scientific journals. Leading optometrists who publish this work should be identified and celebrated.: This work aims to derive publication metrics of the leading optometric researchers worldwide.: An extensive global search was conducted to discover leading optometric researchers; 480 names were identified. A custom-designed bibliographic search tool was developed to interrogate the Scopus database (Elsevier) and extract publication metrics using the unique Scopus Author Identifier number for each optometrist. On 13 January 2021, the full list was reduced to 200 optometrists (the 'Top 200') ranked by h-index - the 'Global Optometrist Top 200 Research Ranking'. The output from the custom tool automatically updates every 24 hours and is available at www.optomrankings.com.: The Top 200 have h-indices ranging from 20 to 67 and have published between 28 and 440 papers. Sixty one (30.5%) are women. Konrad Pesudovs has the highest h-index (67) and citations (51,193). The most prolific author is Robert Hess (442 papers). David Piñero is publishing at the fastest rate (17.6 papers per year). The Top 200 work in 13 nations, of whom 172 (86.0%) work in four nations: USA - 76 (38.0%), Australia - 43 (21.5%), UK - 41 (20.5%) and Canada - 16 (8.0%). Of the 72 institutions represented, the University of California, Berkeley, USA is home to the most Top 200 optometrists (17) and has the highest combined h-index of Top 200 optometrists (132).: The optometric profession is supported by a robust research base, prosecuted by a large international cohort of optometric researchers who publish extensively on a broad range of ophthalmic issues and whose work is highly cited. The 200 most impactful optometrists in the world are identified.
Topics: Australia; Bibliometrics; Databases, Factual; Female; Humans; Optometrists; Optometry
PubMed: 33689668
DOI: 10.1080/08164622.2021.1878863 -
Clinical Optometry 2017Contact lens (CL) wear has been a viable alternative to spectacle wear for several decades. The interest and desire to wear CLs have been stable in recent years,... (Review)
Review
Contact lens (CL) wear has been a viable alternative to spectacle wear for several decades. The interest and desire to wear CLs have been stable in recent years, evidenced by the consistency of new wearers into this category of refractive correction. CLs have become one of the most commonly used medical devices in the market, with more than 40 million wearers in the US. There are many activities in which patients report a preference of CL wear over spectacles (athletics for example). Nearly all patients (even presbyopic patients) have the option of contact lenses today given the expansion of powers and parameters in recent years. Patients eyes are getting dryer as factors of age and the environment. CL materials have improved in recent years in an attempt to meet the challenges of dryer eyes. Despite the improvements in CLs and their care, challenges persist. Patient education, handwashing, compliance with care, and wearing schedule are some of the challenges that providers face in the care of CL patients even today.
PubMed: 30214367
DOI: 10.2147/OPTO.S139651 -
Clinical Optometry 2016Blepharitis is a condition characterized by inflammation of the eyelid margin and is a common cause of discomfort and irritation among people of all ages, ethnicity, and... (Review)
Review
Blepharitis is a condition characterized by inflammation of the eyelid margin and is a common cause of discomfort and irritation among people of all ages, ethnicity, and sex. In general, blepharitis is not a sight-threatening condition, but if left untreated has the potential to cause keratopathy, corneal neovascularization and ulceration, and permanent alterations in eyelid morphology. Historically, blepharitis has been categorized according to multiple structural classifications, including anatomic location, duration, and etiology. The substantial overlap of symptoms and signs from the differing structural classifications has led to initial misdiagnoses, clinical underreporting, and variability in treatment of blepharitis. The multifactorial nature is still not fully appreciated but infection and inflammation have been identified as the primary contributors. Ongoing clinical research continues the pursuit for a treatment panacea; however, long-term management of the underlying causes of blepharitis remains the best clinical approach. Here, we will attempt to review the existing literature as it pertains to clinical management of blepharitis and address a stepwise approach to diagnosis, treatment, and management.
PubMed: 30214351
DOI: 10.2147/OPTO.S84795 -
Clinical & Experimental Optometry Jan 2024
Topics: Humans; Optometrists; Fear
PubMed: 38225195
DOI: 10.1080/08164622.2023.2267552