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Health Science Reports Nov 2023To report the scope of optometry practice in Trinidad and Tobago to identify areas that need improvement.
BACKGROUND AND AIM
To report the scope of optometry practice in Trinidad and Tobago to identify areas that need improvement.
METHODS
A cross-sectional study of optometrists in Trinidad and Tobago was conducted using a validated self-structured questionnaire. Data obtained was exported to the Statistical Package for Social Sciences. Descriptive analysis and Pearson were used to summarize the demographic data and determine associations, respectively.
RESULT
A total of 63 optometrists participated in the study. Majority of them were females (69.8%, = 44), Christians (65.1%), East Indians (47.6%), and 30 years and below (66.7%). Most (87%) of them utilized routine optometric equipment in their clinical practice including autorefractors, retinoscopes, direct ophthalmoscopes, lensometers, phoropters, slit lamp biomicroscopes, trial lens boxes, and visual acuity chart projectors. A few of them have noncontact tonometer (4.8%), Volk lenses (1.6%), and perform color vision tests (1.6%). Fewer (12.7%, = 8) practitioners provided low-vision services. The use of pharmaceutical agents was prevalent among the participants (55.6%). Additionally, the provision of contact lenses was the most frequently practiced service among the participants (85.7%, = 54). A significant association was observed between the provision of low-vision services and sex ( = 0.03).
CONCLUSION
The scope of optometry practice in Trinidad and Tobago is in accordance with the basic guidelines set out by the World Council of Optometry but there is need to get more involved in the provision of low vision and other specialty services.
PubMed: 37920658
DOI: 10.1002/hsr2.1667 -
BJGP Open Apr 2024Vision impairment can have an impact on cognition, health, and social function. Vision loss may be avoided if detected early and treated promptly. Eye health is a minor...
BACKGROUND
Vision impairment can have an impact on cognition, health, and social function. Vision loss may be avoided if detected early and treated promptly. Eye health is a minor topic in general practice, but the ongoing relationship between doctor and patient has the potential to assist the patient in navigating the healthcare system and guaranteeing timely healthcare service delivery.
AIM
To explore the attitudes of older members of the public (aged ≥60 years) towards navigating primary sector eye health care in Denmark, with a focus on optometrists, practising ophthalmologists (POs), and GPs.
DESIGN & SETTING
Qualitative study in Copenhagen, Denmark.
METHOD
Focus group interviews were performed in the spring of 2022 with 21 older members of the public.
RESULTS
Older members of the public perceived optometrists and POs to be the most relevant health professionals to consult about eye health. Opportunities were identified for enhancing the function of general practice including detecting early signs of visual impairment, being in charge of further referrals, and managing issues affecting quality of life such as dry eyes.
CONCLUSION
Older members of the public sought help from health professionals who are directly qualified to treat symptoms of vision impairment that patients are experiencing or expect to face in the near future. Participants identified a potential for GPs to address vision impairment. This included focusing on the patient's general health and function, as well as potential comorbidities influencing treatment trajectories. The current denigration of general practice risks missing out on the potential benefits of robust engagement from general practice in eye health.
PubMed: 37903529
DOI: 10.3399/BJGPO.2023.0118 -
European Journal of Ophthalmology Oct 2023Myopia management is practiced by ophthalmologists and optometrists This study evaluated the approach and standard of myopia management among eye-care practitioners...
PURPOSE
Myopia management is practiced by ophthalmologists and optometrists This study evaluated the approach and standard of myopia management among eye-care practitioners (ECPs) in Israel. The findings may ultimately affect the quality of care.
METHODS
A questionnaire was sent to 954 optometrists and 365 ophthalmologists, including demographic questions; whether they owned any devices to monitor myopia progression; the lowest progression they considered significant; various questions pertaining to myopia management and treatment methods.
RESULTS
Responses from 135 optometrists and 126 ophthalmologists were collected, the majority practicing more than five years; 94% of optometrists, and 64% of ophthalmologists. Around 53% of optometrists and 27% of the ophthalmologists proclaimed to practice myopia management. ECPs primary parameters influencing risk assessment for progression were age, genetic background and history of progression. Time outdoors, during daylight hours, is advised by ophthalmologists (97%) and optometrists (78%). Limiting screentime is encouraged by 87% of ophthalmologists and 69% of optometrists. Myopia progression of 0.50D-0.75D after six months is regarded to require intervention by 93% of ophthalmologists and 83% of optometrists. Optometrists selected multiple myopia management treatments, primarily optical (ophthalmic myopia management lenses 40%, multifocal ophthalmic lenses 24%, peripheral blur contact lenses 38%, orthokeratology 11%), while 95% of ophthalmologists chose atropine and only 3-11% selected any additional treatments to consider.
CONCLUSION
This study highlighted ECPs' agreement on the principles, importance of, and timeline of intervention with myopia management. The disconnect between the two professions lies in management methods. Genuine dialogue and co-management should be encouraged for maximum implementation, benefit and effectiveness of available patient treatments.
PubMed: 37899737
DOI: 10.1177/11206721231211465 -
Journal of Optometry 2024This study analyses strategies and attitudes on myopia management reported by eye care practitioners (ECP) from Spain in 2022.
OBJECTIVE
This study analyses strategies and attitudes on myopia management reported by eye care practitioners (ECP) from Spain in 2022.
METHODS
A questionnaire was distributed to ECPs worldwide via the internet through professional associations. The questionnaire was distributed by email to all registered Spanish optician-optometrists. Questions examined awareness of increasing myopia prevalence; perceived efficacy; uptake of available approaches; and reasons preventing further uptake of specific approaches.
RESULTS
Of 3,107 practitioners who participated in the study, 380 were Spanish ECPs. Using a 10-point scale, Spanish practitioners reported less concern about increasing pediatric myopia (8.3 ± 1.6) compared to ECP's worldwide (8.5 ± 1.9) (p < 0.001), but similar level of clinical activity in myopia control (7.8 ± 2.3 vs. 7.5 ± 2.5, respectively) (p > 0.05); however, around half of all prescribed treatments were single-vision distance spectacles/contact lenses both in Spain and in most regions, with Spanish practitioners prescribing less single-vision spectacles than African and Asian (p < 0.001), but more than Australasian practitioners (p = 0.04). No significant differences were found between Spain and the other regions in the perceived efficacy of combined therapy, orthokeratology, and outdoor time (p > 0.05), with the former being perceived as the most effective myopia control method followed by orthokeratology. No significant differences were found between Spain and the world's average in factors preventing the prescription of myopia control approaches (p > 0.05). Spanish practitioners reported that embracing myopia management has a positive, but lower impact on customer loyalty, practice revenue and job satisfaction compared with the other regions (all p < 0.001).
CONCLUSIONS
Myopia control is increasing, although around half of practitioners still prescribe single-vision distance spectacles/contact lenses to young/progressive myopes. Combined therapy followed by orthokeratology were perceived as the most effective treatments. Embracing myopia management improved patient loyalty and job satisfaction.
Topics: Humans; Child; Spain; Myopia; Contact Lenses; Surveys and Questionnaires; Optometrists
PubMed: 37879183
DOI: 10.1016/j.optom.2023.100496 -
Sichuan Da Xue Xue Bao. Yi Xue Ban =... Sep 2023To explore the application value of applying deep learning (DL) algorithm in the grading assessment of corneal fluorescein staining.
OBJECTIVE
To explore the application value of applying deep learning (DL) algorithm in the grading assessment of corneal fluorescein staining.
METHODS
A cross-sectional study was carried out, covering 600 corneal fluorescein staining photos acquired in the Contact Lens Clinic, West China Hospital, Sichuan University between 2020 and 2022. Out of the 600 photos, 500 were used to construct the algorithm and the remaining 100 were used for the validation of the algorithm and a comparative analysis of the difference in grading accuracy (ACC) and the length of diagnostic time between artificial intelligence (AI) and optometry students. One month after finishing the first grading analysis, assessment by AI and optometry students was conducted for a second time and results from the two rounds of assessment were compared to examine the intrarater agreement ( value) of the two analyses. The grading analysis results of 3 experienced optometrists were used as the gold standard in the study.
RESULTS
Findings of the cross validation with the complete dataset, the training dataset, and the test dataset showed that ResNet34 had the highest predictive accuracy among four DL models. ResNet34 DL model achieved an accuracy of 93.0%, sensitivity of 89.5%, and specificity of 89.6% in the grading of corneal staining. In the comparison of the grading accuracy of AI and two optometry students, AI showed better accuracy, with the respective grading accuracy being 87.0%, 78.0%, and 52.0% for AI, student 1, and student 2 ( =0.001). In addition, the average diagnostic time of AI was shorter than that of optometry students ( =1.00 s, =11.86 s, =13.25 s, =0.001). In the comparative analysis of the intrarater agreement between the two assessments, AI ( =0.658, =0.001) achieved better consistency than the two optometry students did ( =0.575, =0.001; =0.609, =0.001).
CONCLUSION
Applying deep learning algorithms in the grading assessment of corneal fluorescein staining has considerable feasibility and clinical value. In the performance comparison between AI and optometry students, AI achieved higher accuracy and better consistency, which indicates that AI has potential application value for assisting optometrists to make clinical decisions with speed and accuracy.
Topics: Humans; Fluorescein; Artificial Intelligence; Deep Learning; Cross-Sectional Studies; Algorithms; Staining and Labeling
PubMed: 37866945
DOI: 10.12182/20230960104 -
BMJ Open Ophthalmology Oct 2023With a paradigm shift in geographic atrophy (GA) treatments now available, establishing consensus on the identification and diagnosis of the disease along with...
BACKGROUND/AIMS
With a paradigm shift in geographic atrophy (GA) treatments now available, establishing consensus on the identification and diagnosis of the disease along with considerations for management of patients with GA will assist eye care professionals (ECP) in their day-to-day practices, leading to improved patient outcomes.
METHODS
A modified Delphi panel process (Geographic Atrophy Management Consensus) consisting of three total surveys and one virtual live meeting held between survey 2 and survey 3. Data were collected from July to October 2022. Participants included expert members of the eye care community that have demonstrated outstanding leadership among peers: a steering committee with three ECPs and a 15-member panel divided between five optometrists, five comprehensive ophthalmologists and five retina specialists. Consensus on statements related to the management of patients with GA was calculated using the RAND/UCLA Appropriateness Method.
RESULTS
At the conclusion of the third survey, consensus was reached on 91% of the 77 statements. Critical consensus topics include: (1) optical coherence tomography as the favoured method to diagnose and monitor GA, (2) preferred practice patterns regarding referral of patients to retina specialists and (3) treatment criteria given the advent of emerging therapeutics for GA.
CONCLUSIONS
Generating awareness of early signs of disease development, progression and identifying the best tools to evaluate GA establishes ideal management and referral strategies. Given the paradigm shift in GA management driven by approved therapies, coupled with the fact that the disease is progressive resulting in devastating vision loss, these strategies are critical to ensure best overall outcomes.
Topics: Humans; Consensus; Geographic Atrophy; Retina; Optometrists
PubMed: 37857560
DOI: 10.1136/bmjophth-2023-001395 -
Diagnostics (Basel, Switzerland) Oct 2023A well-known eye disorder called diabetic retinopathy (DR) is linked to elevated blood glucose levels. Cotton wool spots, confined veins in the cranial nerve, AV...
A well-known eye disorder called diabetic retinopathy (DR) is linked to elevated blood glucose levels. Cotton wool spots, confined veins in the cranial nerve, AV nicking, and hemorrhages in the optic disc are some of its symptoms, which often appear later. Serious side effects of DR might include vision loss, damage to the visual nerves, and obstruction of the retinal arteries. Researchers have devised an automated method utilizing AI and deep learning models to enable the early diagnosis of this illness. This research gathered digital fundus images from renowned Pakistani eye hospitals to generate a new "DR-Insight" dataset and known online sources. A novel methodology named the residual-dense system (RDS-DR) was then devised to assess diabetic retinopathy. To develop this model, we have integrated residual and dense blocks, along with a transition layer, into a deep neural network. The RDS-DR system is trained on the collected dataset of 9860 fundus images. The RDS-DR categorization method demonstrated an impressive accuracy of 97.5% on this dataset. These findings show that the model produces beneficial outcomes and may be used by healthcare practitioners as a diagnostic tool. It is important to emphasize that the system's goal is to augment optometrists' expertise rather than replace it. In terms of accuracy, the RDS-DR technique fared better than the cutting-edge models VGG19, VGG16, Inception V-3, and Xception. This emphasizes how successful the suggested method is for classifying diabetic retinopathy (DR).
PubMed: 37835859
DOI: 10.3390/diagnostics13193116 -
Clinical Medicine Insights.... 2023Artificial intelligence (AI) appears capable of detecting diabetic retinopathy (DR) with a high degree of accuracy in adults; however, there are few studies in children...
BACKGROUND
Artificial intelligence (AI) appears capable of detecting diabetic retinopathy (DR) with a high degree of accuracy in adults; however, there are few studies in children and young adults.
METHODS
Children and young adults (3-26 years) with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) were screened at the Dhaka BIRDEM-2 hospital, Bangladesh. All gradable fundus images were uploaded to Cybersight AI for interpretation. Two main outcomes were considered at a patient level: 1) Any DR, defined as mild non-proliferative diabetic retinopathy (NPDR or more severe; and 2) Referable DR, defined as moderate NPDR or more severe. Diagnostic test performance comparing Orbis International's Cybersight AI with the reference standard, a fully qualified optometrist certified in DR grading, was assessed using the Matthews correlation coefficient (MCC), area under the receiver operating characteristic curve (AUC-ROC), area under the precision-recall curve (AUC-PR), sensitivity, specificity, positive and negative predictive values.
RESULTS
Among 1274 participants (53.1% female, mean age 16.7 years), 19.4% (n = 247) had any DR according to AI. For referable DR, 2.35% (n = 30) were detected by AI. The sensitivity and specificity of AI for any DR were 75.5% (CI 69.7-81.3%) and 91.8% (CI 90.2-93.5%) respectively, and for referable DR, these values were 84.2% (CI 67.8-100%) and 98.9% (CI 98.3%-99.5%). The MCC, AUC-ROC and the AUC-PR for referable DR were 63.4, 91.2 and 76.2% respectively. AI was most successful in accurately classifying younger children with shorter duration of diabetes.
CONCLUSIONS
Cybersight AI accurately detected any DR and referable DR among children and young adults, despite its algorithms having been trained on adults. The observed high specificity is particularly important to avoid over-referral in low-resource settings. AI may be an effective tool to reduce demands on scarce physician resources for the care of children with diabetes in low-resource settings.
PubMed: 37822362
DOI: 10.1177/11795514231203867 -
Journal of Medical Signals and Sensors 2023In this article, a smart visual acuity measurement (VAM) system is designed and implemented. Hardware of the proposed VAM system consists of two parts: a wireless remote...
In this article, a smart visual acuity measurement (VAM) system is designed and implemented. Hardware of the proposed VAM system consists of two parts: a wireless remote controller, and a high-resolution LCD controlled through a Raspberry-Pi mini-computer. In the remote controller, a 3.5" graphical LCD with a touch screen is used as a human-machine interface. When a point is pressed on the touch screen, the unique identifier (ID) code of that point as well as its page number is transmitted to the Raspberry-Pi. In the Raspberry-Pi, data are received and processed by a smart application coded in visual studio software. Then, the commanded tasks are executed by the Raspberry-Pi's operating system. Numerous charts, characters, and pictures are stored in the proposed VAM system to provide various VAM options while the size of the optotypes is adjusted automatically based on the distance of the patient from the LCD. The performance of the proposed VAM system is examined practically under the supervision of an expert optometrist where the results indicate that visual acuity, astigmatism, and color blindness of patients can be examined precisely through the proposed VAM system in an easier and more comfortable manner.
PubMed: 37809013
DOI: 10.4103/jmss.jmss_38_22