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BMC Health Services Research Jan 2024Developing countries such as Kenya still experience challenges around human resource to deliver refractive error services. However, given the burden of uncorrected... (Review)
Review
BACKGROUND
Developing countries such as Kenya still experience challenges around human resource to deliver refractive error services. However, given the burden of uncorrected refractive error, adoption of innovative and cost effective approaches is desirable. Hence this study intended to develop a task shifting framework integrated with telemedicine to potentially scale refractive error services.
METHODS
This was an exploratory study conducted in four phases as follows: a scoping review of the scope of practice for ophthalmic workers in Kenya, an interview with key opinion leaders on the need for integration of public health approaches such as the vision corridors within the eye health ecosystem in Kenya and their knowledge on task shifting, and finally development and validation of a proposed task shifting framework through a Delphi technique. Purposive sampling was used to recruit key opinion leaders and data was collected via telephonic interviews. The qualitative data was analyzed thematically using NVivo Software, Version 11.
RESULTS
The scoping review showed that only optometrists, ophthalmologists and ophthalmic clinical officers are allowed to undertake refraction in Kenya. All of the key opinion leaders (100%) were aware of task shifting and agreed that it is suitable for adoption within the eye health ecosystem in Kenya. All of the key opinion leaders (100%) agreed that skills development for healthcare workers without prior training on eye health supervised by optometrists through telemedicine is desirable. Notwithstanding, all of the key opinion leaders (100%) agreed that integration of public health approaches such as the vision corridors across all levels of healthcare delivery channels and development of a self-assessment visual acuity tool is desirable. Finally all of the key opinion leaders (100%) agreed that task shifting is relevant for adoption within the eye health ecosystem in Kenya. The developed framework prioritized partnership, advocacy, skills development, establishment and equipping of refraction points. The proposed framework advocated for a telemedicine between professionals with conventional training and those with skills development.
CONCLUSION
Task shifting integrated with telemedicine could cost effectively scale refractive error service delivery. However, internal and external factors may hinder the success warranting the need for a multi-faceted interventions and a connection between planning and training to scale the uptake.
Topics: Humans; Kenya; Delphi Technique; Ecosystem; Task Shifting; Refractive Errors; Telemedicine
PubMed: 38254104
DOI: 10.1186/s12913-024-10618-8 -
Journal of Ophthalmic & Vision Research 2023To assess the repeatability of Pentacam AXL as a Scheimpflug-based system or measuring axial length according to the age, sex, lens type, axial length value, and type of...
PURPOSE
To assess the repeatability of Pentacam AXL as a Scheimpflug-based system or measuring axial length according to the age, sex, lens type, axial length value, and type of cataract.
METHODS
The present study was conducted using multistage cluster sampling in Tehran, Iran. Ocular biometry was performed, using the Pentacam AXL, by an experienced optometrist on all the participants. The axial length (AL) measurements were taken thrice, with a gap of 10 minutes. To evaluate the repeatability, the intraclass correlation coefficient (ICC) and the repeatability coefficient (RC) were calculated. To determine the significant difference in the repeatability index among study variables, the tolerance index (TI) was calculated.
RESULTS
In this report, 897 eyes of 677 individuals aged between 20 and 91 years (mean SD: 64.90 13.62 years) were reported. The ICC of the axial length measurements was 0.981 for all cases. Based on the within-subject standard deviation, the RC was 0.401. The ICC was 0.976 and 0.985 in men and women, respectively. The TI showed better RC of measurements among females. The ICC decreased from 0.999 in participants under 40 years to 0.973 in individuals over 60 years of age. The TI showed a decrease in RC with advancing age. The RC was worse in eyes with nuclear cataracts; the RC was also worse in the first quartile of the signal-to-noise ratio (SNR) compared to the other SNR quartiles.
CONCLUSION
The Scheimpflug-based systemPentacam AXL had high repeatability in measuring axial length. Some variables such as male gender, older age, and nuclear cataract were associated with reduced repeatability of the measurements. A higher SNR was associated with better repeatability of the axial length measurements.
PubMed: 38250225
DOI: 10.18502/jovr.v18i4.14551 -
Frontiers in Medicine 2023The current study designed a unique type of corneal topography evaluation method based on deep learning and traditional image processing algorithms. The type of corneal...
PURPOSE
The current study designed a unique type of corneal topography evaluation method based on deep learning and traditional image processing algorithms. The type of corneal topography of patients was evaluated through the segmentation of important medical zones and the calculation of relevant medical indicators of orthokeratology (OK) lenses.
METHODS
The clinical data of 1,302 myopic subjects was collected retrospectively. A series of neural network-based U-Net was used to segment the pupil and the treatment zone in the corneal topography, and the decentration, effective defocusing contact range, and other indicators were calculated according to the image processing algorithm. The type of corneal topography was evaluated according to the evaluation criteria given by the optometrist. Finally, the method described in this article was used to evaluate the type of corneal topography and compare it with the type classified by the optometrist.
RESULTS
When the important medical zones in the corneal topography were segmented, the precision and recall of the treatment zone reached 0.9587 and 0.9459, respectively, and the precision and recall of the pupil reached 0.9771 and 0.9712. Finally, the method described in this article was used to evaluate the type of corneal topography. When the reviewed findings based on deep learning and image processing algorithms were compared to the type of corneal topography marked by the professional optometrist, they demonstrated high accuracy with more than 98%.
CONCLUSION
The current study provided an effective and accurate deep learning algorithm to evaluate the type of corneal topography. The deep learning algorithm played an auxiliary role in the OK lens fitting, which could help optometrists select the parameters of OK lenses effectively.
PubMed: 38239613
DOI: 10.3389/fmed.2023.1264659 -
The Malaysian Journal of Medical... Dec 2023Certified training must be provided for lay vision screeners prior to their conduct of a vision screening programme. However, the effectiveness of trained lay screeners...
BACKGROUND
Certified training must be provided for lay vision screeners prior to their conduct of a vision screening programme. However, the effectiveness of trained lay screeners does deteriorate over time. This study aims to evaluate the effectiveness of a recertification vision screening training module using the KieVision Preschool Vision Screening Kit for preschool teachers in Malaysia.
METHODS
This was a randomised control trial. Fifty-nine preschool teachers previously enrolled in a Knowledge Transfer Programme were divided into a Study Group ( = 31) to receive recertification training and a Control Group ( = 28) to attend briefing sessions. Subjects was then asked to perform vision screening on 15 preschool children aged 4 years old-6 years old at their respective premises, then verified by optometrists after 2 weeks from the initial screening on the same children.
RESULTS
A total of 894 children were screened, with the Study Group and Control Group screened 49.7% and 50.3%, respectively. There was higher validity in vision screening findings from the Study Group (sensitivity = 66.7%, positive predictive value (PPV) = 61.5%) compared to the Control Group (sensitivity = 36.0 %, PPV = 40.9%).
CONCLUSION
Teachers who received recertification training were more competent in detecting children's vision impairment using KieVision Preschool Vision Screening Kit. Thus, timely recertification training should be emphasised to ensure sustainable consistency and reliability of vision screening programmes conducted by lay vision screeners.
PubMed: 38239245
DOI: 10.21315/mjms2023.30.6.14 -
BMC Medical Research Methodology Jan 2024Community optometrists in Scotland have performed regular free-at-point-of-care eye examinations for all, for over 15 years. Eye examinations include retinal imaging but...
BACKGROUND
Community optometrists in Scotland have performed regular free-at-point-of-care eye examinations for all, for over 15 years. Eye examinations include retinal imaging but image storage is fragmented and they are not used for research. The Scottish Collaborative Optometry-Ophthalmology Network e-research project aimed to collect these images and create a repository linked to routinely collected healthcare data, supporting the development of pre-symptomatic diagnostic tools.
METHODS
As the image record was usually separate from the patient record and contained minimal patient information, we developed an efficient matching algorithm using a combination of deterministic and probabilistic steps which minimised the risk of false positives, to facilitate national health record linkage. We visited two practices and assessed the data contained in their image device and Practice Management Systems. Practice activities were explored to understand the context of data collection processes. Iteratively, we tested a series of matching rules which captured a high proportion of true positive records compared to manual matches. The approach was validated by testing manual matching against automated steps in three further practices.
RESULTS
A sequence of deterministic rules successfully matched 95% of records in the three test practices compared to manual matching. Adding two probabilistic rules to the algorithm successfully matched 99% of records.
CONCLUSIONS
The potential value of community-acquired retinal images can be harnessed only if they are linked to centrally-held healthcare care data. Despite the lack of interoperability between systems within optometry practices and inconsistent use of unique identifiers, data linkage is possible using robust, almost entirely automated processes.
Topics: Humans; Medical Record Linkage; Medical Records; Medical Records Systems, Computerized; Data Collection; Scotland
PubMed: 38233744
DOI: 10.1186/s12874-024-02143-3 -
PloS One 2024Keratoconus is the most common primary corneal ectasia and is associated with significant morbidity. In its early stages, keratoconus is often asymptomatic, making the...
Keratoconus is the most common primary corneal ectasia and is associated with significant morbidity. In its early stages, keratoconus is often asymptomatic, making the identification of subclinical disease challenging. Refractive error is a parameter that is documented at most routine optometry visits, yet interestingly, changes in refraction of keratoconic patients over time have not yet been studied and compared with the general population. Early diagnosis of keratoconus facilitates timely referral for treatments such as corneal collagen cross-linking, which has been shown to slow disease progression. In this context, documenting delays between initial presentation to the optometrist and referral for collagen-cross-linking as well as comparing the trends in visual acuity and refractive error between keratoconic and non-keratoconic patients over time are particularly relevant.
Topics: Humans; Keratoconus; Treatment Delay; Corneal Topography; Australia; Refractive Errors; Cross-Linking Reagents; Photosensitizing Agents; Riboflavin; Ultraviolet Rays
PubMed: 38206955
DOI: 10.1371/journal.pone.0297268 -
The British and Irish Orthoptic Journal 2024The optometrist is often one of the professionals patients consult when they have headaches. The limitations inherent in previous studies on the topic limit the...
BACKGROUND & AIM
The optometrist is often one of the professionals patients consult when they have headaches. The limitations inherent in previous studies on the topic limit the utilization of their findings. Therefore, the aim of conducting the present study was to explore correlations between headache and refractive errors in a clinical setting using extended classification criteria.
METHODS
The study design was cross-sectional, and sample comprised (headache group = 1062; non-headache group = 1095) participants aged 10-40 years who attended an optometry practice. During case-history taking, participants were classified as headache and non-headache group. Refraction, ocular health examinations, accommodative and vergence tests were performed. Headaches were sub-classified according to the anatomic location such as temporal, frontal, occipital, or diffuse, based on where pain was felt.
RESULTS
Temporal and temporo-frontal headaches were most frequent. Participants in the numbered 1062 with mean age 25.1 ± 8.6; females 841 (79.1%) and males 221 (20.8%) while those in the numbered 1095 with mean age 25.3 ± 8.7; females 648 (59.1%). Low amount spheres and cylinders ( = 0.003) as well as hyperopic, and against-the-rule astigmatism ( = 0.012) and ( = 0.03) respectively were significantly more frequent in the headache group.
CONCLUSION
Temporal headaches were most frequent. Patients with low spheres and cylindrical errors as well as hyperopic and against-the-rule astigmatism were significantly more prone to headaches. This study provides findings, which have not been reported. Findings have implications for clinical practice and highlights the need to compensate for low ametropia. A standard study protocol is recommended.
PubMed: 38187096
DOI: 10.22599/bioj.313 -
Journal of Optometry 2024Given the increase in demand for optometry services by society and the importance of the Optometry profession in Portugal and Spain, the objective of this study was to... (Observational Study)
Observational Study
PURPOSE
Given the increase in demand for optometry services by society and the importance of the Optometry profession in Portugal and Spain, the objective of this study was to determine job satisfaction and important factors related to this satisfaction in a sample of Portuguese and Spanish optometrists.
METHODS
A prospective, cross-sectional, and observational study was carried out from June to December 2021. An adaptation of the 15-item job satisfaction in eye-care personnel (JSEP) questionnaire validated by Paudel et al. was administered to Portuguese and Spanish optometrists. The questionnaire was shared through different social media (Facebook, LinkedIn, WhatsApp, etc.) in a Google form during the months of June to December 2021 in Portugal and Spain.
RESULTS
A total of 530 surveys were collected in Portugal (42.3%; n = 224) and Spain (57.7%; n = 306). The factors that most influence overall job satisfaction are salary, career development opportunities, recognition/prestige in society, good work-life balance (all p<0.001), workplace equipment and facilities, and encouragement reward positive feedback (both p = 0.002). When comparing the determinants of job satisfaction of optometrists, it was found that Portuguese professionals were generally more satisfied than Spanish ones (p<0.001). However, Spanish optometrists reported feeling more supported by their colleagues (p<0.001).
CONCLUSION
This study has shown that the level of job satisfaction was higher in Portugal than in Spain. The most important factors influencing job satisfaction were salary, job stability, and support from colleagues.
Topics: Humans; Job Satisfaction; Portugal; Optometrists; Cross-Sectional Studies; Prospective Studies; Surveys and Questionnaires
PubMed: 38171112
DOI: 10.1016/j.optom.2023.100492 -
Eye (London, England) May 2024
Comparative Study
Topics: Humans; United Kingdom; Ophthalmology; Retinal Diseases; Optometrists; Clinical Competence; Education, Medical, Graduate; Eye Diseases; Health Knowledge, Attitudes, Practice; Optometry; Surveys and Questionnaires
PubMed: 38151527
DOI: 10.1038/s41433-023-02909-x -
Clinical Ophthalmology (Auckland, N.Z.) 2023To assess the difference in course and final visual outcome of keratitis (AK) patients based on the first healthcare provider (HCP) seen.
BACKGROUND
To assess the difference in course and final visual outcome of keratitis (AK) patients based on the first healthcare provider (HCP) seen.
METHODS
Retrospective observational cohort study of AK patients admitted to the Manchester Royal Eye Hospital between 2003 and 2017. HCPs were grouped (Group 1: Optometrists, Opticians; Group 2: General Practitioners (GPs); Group 3: Ophthalmologists) and the data analyzed on demographics, risk factors, clinical history, clinical features, and subspecies.
RESULTS
Forty-one patients with unilateral culture-proven AK were included. Median time to consultation with first HCP was 7 days (IQR 4-14 days), while mean time to the correct diagnosis of AK was 15 days (IQR 7-29 days). Patients saw an optician, optometrist or ophthalmologists significantly earlier than GPs (median 4 days, vs 15 or 5 days, respectively, p = 0.04). Bacterial keratitis was the most common initial clinical diagnosis (43%). The shortest time to making the AK diagnosis (median 11 days) and the highest rate of initiating AK treatment started at the first visit (38%) were both in the ophthalmologists' group. No significant differences were observed in initial and final visual acuity between HCP groups (p = 0.36).
CONCLUSION
AK patients often seek ocular help earlier from optometrists and opticians than medical doctors. Final clinical outcomes did not significantly differ based on the first HCP seen, but ophthalmologists were more likely to make the diagnosis of AK and initiate anti-amoebal therapy faster than other HCPs. Greater education and collaboration between ophthalmologists and other HCPs to increase awareness of AK are needed.
PubMed: 38146454
DOI: 10.2147/OPTH.S438990