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PloS One 2024Uncorrected refractive errors pose a significant challenge globally, particularly in remote regions of low-middle income countries where access to optometric care is...
INTRODUCTION
Uncorrected refractive errors pose a significant challenge globally, particularly in remote regions of low-middle income countries where access to optometric care is often limited. Telerefraction, which involves refraction by a trained technician followed by real-time consultation with remote optometrist, is a promising approach for such remote settings. This study aimed to evaluate the accuracy of this model.
METHODS
This prospective study, conducted in New Delhi, compared tele-refraction to in-person examinations. Trained technicians used a simple device, Click-check, to perform objective refraction and a tele-refraction platform to enter the findings of objective refraction. Final prescription was made after consulting a remote optometrist on that platform. Masked face-to-face optometrists served as the gold standard. The study involved refraction in 222 patients and 428 eyes.
RESULTS
Tele-refraction demonstrated a strong agreement with in-person optometry, achieving 84.6% in spherical correction and 81% conformity in spherical equivalent. The mean difference of spherical equivalent between the two arms was only 0.11 D. The consultation with a remote optometrist improved conformity of spherical equivalent by 14.8% over objective refraction. 82 percent eyes matched in best corrected visual acuity and 92 percent were within 0.1 logMAR difference. For cylindrical axis, 74% eye were within acceptable 10 degrees of difference. The mismatch amongst the individual trained technicians, in terms of difference between the tele-refraction arm and the face-to face optometrist arm was found to be significant for cylindrical axis and not for spherical power and spherical equivalent.
CONCLUSION
Our study found tele-refraction by a trained technician comparable to refraction done by face-to-face optometrist. Tele-refraction, coupled with remote optometrist guidance can address the optometry resource gap in underserved areas. Thus, this model offers a transformative approach to enhancing the accessibility and quality of eye care services, which can significantly contribute to our efforts in achieving the global targets set by the World Health Organization for effective refractive error coverage. More standardized training for these technicians on ClickCheckTM for detecting the cylindrical axis with better accuracy, can improve this model further.
Topics: Humans; Refractive Errors; Adult; Female; Male; Prospective Studies; Remote Consultation; Optometrists; Middle Aged; Reproducibility of Results; Optometry; Telemedicine; Young Adult; Adolescent; Refraction, Ocular; Visual Acuity; Aged
PubMed: 38913708
DOI: 10.1371/journal.pone.0299491 -
Journal of Clinical Medicine May 2024: Refractive errors, including myopia, hyperopia, and astigmatism, are the leading causes of visual impairment in school-aged children and can significantly impact their...
: Refractive errors, including myopia, hyperopia, and astigmatism, are the leading causes of visual impairment in school-aged children and can significantly impact their academic performance and quality of life. This study aimed to assess the prevalence of refractive errors among school children from economically disadvantaged areas in Northwest México, using a consistent methodology to facilitate comparison with global data. : We adopted the Refractive Error Study in Children (RESC) protocol by the World Health Organization to examine the prevalence of myopia, hyperopia, and astigmatism. The study comprised a systematic sampling of children aged 6 to 18 years from diverse schools in Northwest México. Trained optometrists conducted visual acuity testing and autorefraction, while ophthalmologists performed cycloplegic refraction to ensure accuracy. : The study found a myopia (SE ≤-1.50 D at least one eye) prevalence of 14.55% (95% CI: 13.27-15.91), with a higher incidence in females (6.92%) compared to males (6.00%) in at least one eye. Hyperopia (SE ≥ +1.00 D at least one eye) was less common, at 3.23% (95% CI: 2.61-3.95), with a slightly higher occurrence in males in at least one eye. Astigmatism (Cylinder ≥ 0.75 D at least one eye) was present in 18.63% (95% CI: 17.21-20.12) of the students in at least one eye, with no significant difference between genders. These findings are consistent with other studies in regions such as Puerto Rico and Iran, indicating widespread refractive error issues among schoolchildren. : The high prevalence of refractive errors, particularly myopia and astigmatism, highlights the critical need for regular vision screenings in schools and the implementation of public health interventions to provide corrective eyewear. Our study confirms the importance of utilizing standardized methodologies like the RESC protocol to compare refractive error prevalence across different geographical and socio-economic contexts, thereby informing global public health strategies.
PubMed: 38892805
DOI: 10.3390/jcm13113094 -
Community Eye Health 2024
PubMed: 38827973
DOI: No ID Found -
Community Eye Health 2024
PubMed: 38827970
DOI: No ID Found -
Community Eye Health 2024
PubMed: 38827966
DOI: No ID Found -
Cureus May 2024Introduction In Florida, mandated school vision screenings begin around the age of five.However, a joint statement in the ophthalmology community recommends that primary...
Introduction In Florida, mandated school vision screenings begin around the age of five.However, a joint statement in the ophthalmology community recommends that primary care providers, including pediatricians, screen for eye and vision symptoms and signs starting at birth. This suggests that pediatricians may be the first to catch signs of early vision loss and refer pediatric patients to an ophthalmologist. This study aims to understand the current vision screening practices of a sample of pediatricians in Florida and how comfort levels with vision screenings may impact ophthalmology referrals. Methods A survey with 36 questions was created by the authors of the study and sent to pediatricians through digital newsletters to the Florida Chapter of the American Academy of Pediatrics and pediatric departments at Florida universities. Descriptive statistics were gathered regarding the demographics of pediatricians surveyed, vision screening attitudes and practices, vision concerns and ophthalmology referrals from pediatric clinics, and the most common reasons for referral to an ophthalmologist. The Jonckheere-Terpstra nonparametric trend test was used to examine whether decreased comfort performing vision screening on a child was associated with lower rates of urgent referrals to an optometrist or ophthalmologist. Results Forty-six responses were collected. Seventy-eight percent of pediatricians reported performing early childhood vision screening (n=36). There was considerable variability in vision screening practices among the pediatricians studied, with only 66% beginning screenings from zero to two years of age (n=24). Fifty percent of respondents reported receiving no previous training on performing vision screening, and less than half of respondents reported feeling "somewhat comfortable" or "extremely comfortable" with performing the exam (n=22, 48%). The trend between decreased comfort performing pediatric vision screening and lower rates of urgent eye care referrals was approaching statistical significance (p=0.0705). The majority of urgent referrals were provided by respondents who were somewhat or extremely comfortable with screening (n=13, 65%). Conclusion From this sample of pediatricians in Florida, most respondents reported performing early childhood vision screening, but there was notable variability in the way screenings were performed among pediatricians. Moreover, many had never received training on performing the exam or did not feel comfortable performing them. Decreased comfort with vision screenings was almost significantly associated with decreased urgent referrals to an ophthalmologist. Future studies should examine whether increased training on vision screenings may help improve standardization of screening practices among pediatrics and comfort with vision screenings.
PubMed: 38826970
DOI: 10.7759/cureus.59473 -
Journal of Ophthalmic Inflammation and... May 2024Non-infectious uveitis affecting the posterior segment of the eye (NIU-PS) is an inflammatory disease, which can significantly impair visual acuity if not adequately... (Review)
Review
Fluocinolone acetonide 0.2 µg/day intravitreal implant in non-infectious uveitis affecting the posterior segment: EU expert user panel consensus-based clinical recommendations.
BACKGROUND
Non-infectious uveitis affecting the posterior segment of the eye (NIU-PS) is an inflammatory disease, which can significantly impair visual acuity if not adequately treated. Fluocinolone-acetonide sustained-release-0.2 µg/day intravitreal (FAc) implants are indicated for prevention of relapse in recurrent NIU-PS. The aim here was to provide treating clinicians with some consensus-based-recommendations for the clinical management of patients with NIU-PS with 0.2 µg/day FAc implants.
METHODS
A European-clinical-expert-group agreed to develop a consensus report on different issues related to the use of FAc implants in patients with NIU-PS.
RESULTS
The Clinical-expert-panel provided specific recommendations focusing on clinical presentation (unilateral/bilateral) of the NIU-PS; systemic involvement of NIU-PS and the lens status. Treatment algorithms were developed; one that refers to the management of patients with NIU-PS in clinical practice and another that establishes the best clinical scenarios for the use of FAc implants, both as monotherapy and as adjuvant therapy. Additionally, the Clinical-expert-panel has provided recommendations about the use of the FAc implants in a clinical-setting. The Clinical-expert-panel also considered the safety profile of FAc implants and their possible implications in the daily practice.
CONCLUSIONS
As more clinical experience has been gained using FAc implants, it was necessary to update the clinical recommendations that guide patient management in the clinic. The current consensus document addresses relevant issues related to the use of FAc implants on different types of patients with various etiologies of NIU-PS, and was conducted to standardize approaches to help specialists obtain better clinical outcomes.
PubMed: 38814386
DOI: 10.1186/s12348-024-00402-4 -
BMC Public Health May 2024Even though the burden of uncorrected refractive error could potentially be addressed through innovative and cost-effective approaches, integration of the services into...
INTRODUCTION
Even though the burden of uncorrected refractive error could potentially be addressed through innovative and cost-effective approaches, integration of the services into the National Health Services (NHS) is desirable. However, minimal information exists on the current situation warranting the need for evidence about the integration of refractive error service provided by optometrists into the national health services in Kenya.
METHODS
A situation analysis of the Kenyan refractive error services provided by optometrists within the NHS was undertaken based on access to service delivery, service coverage, and human resource. A strengths, weaknesses, opportunities, and threats analysis was undertaken based on the existent evidence to identify the core factors that could potentially facilitate or hinder the integration of refractive error services provided by optometrists within the National Health Services. The proportion of optometrists to be integrated in the NHS was estimated based on the minimum ratios recommended by the World Health Organization.
RESULTS
A section of tertiary and secondary healthcare facilities in Kenya have specific services to address refractive errors within the NHS with most facilities lacking such services. Treatment of refractive error occurs at the level of eye care general services. There are 11,547 health facilities offering primary care services in Kenya. However, none of them offers refractive error services and only a section of facilities offering county health referral services provides eye care services which is limited to refraction without provision of spectacles. The existing workforce comprises of ophthalmologists, optometrists and ophthalmic clinical officers, together with nurses and other general paramedical assistants. Optometrists, ophthalmologists and ophthalmic clinical officers are allowed to undertake refraction. However, optometrists majorly practices in the private sector. Centralization of eye care services in urban areas, weak referral systems, and a shortage in the workforce per population was observed.
CONCLUSIONS
The Kenyan NHS should advocate for primary care and reorient the current hospital-based delivery approach for refractive error services. This is attributed to the fact that provision of refractive error services at primary care remains effective and efficient and could translate to early detection of other ocular conditions. The existing human resources in the eye health ecosystem in Kenya should maximize their efforts towards addressing uncorrected refractive error and optometrists should be integrated into the NHS.
Topics: Kenya; Humans; Refractive Errors; Optometrists; Delivery of Health Care, Integrated; National Health Programs; Health Services Accessibility
PubMed: 38811959
DOI: 10.1186/s12889-024-18960-6 -
Heliyon May 2024This study aimed to explore the practices of optometrists in Hong Kong towards diagnosing and managing dry eye disease (DED).
PURPOSE
This study aimed to explore the practices of optometrists in Hong Kong towards diagnosing and managing dry eye disease (DED).
METHODS
From September 2021 to March 2022, an online questionnaire was distributed to optometrists in Hong Kong through several professional associations. The questionnaire included questions about the importance and usefulness of various diagnostic tests, as well as inquiries about management strategies and recommended follow-up schedules for DED. Responses were compared between optometrists who were more or less proactive in continuing education to identify potential differences.
RESULTS
The analysis included 68 valid responses. Sixty-one of them were Part 1 optometrists that represents 5.5 % of registered Part 1 optometrists back in 2022. Assessment of clinical symptoms was the most commonly performed investigation (93 %) and considered the most important (75 %) procedure in DED assessments, followed by corneal staining and fluorescein tear break-up time. Traditional diagnostic tests were preferred over newer methods, such as osmolarity, which were not yet commonly used. Unpreserved lubricants (90 %) and lid hygiene (63 %) were the primary treatments recommended for mild DED. Optometrists who had more experience and frequent participation in continuing education were more confident in diagnosing and managing DED, and more likely to recommend omega-3 supplements for moderate DED.
CONCLUSION
The diagnostic and management strategies of optometrists in Hong Kong were generally consistent with the recommendations of the Dry Eye Workshop II report. However, standardized DED questionnaires and newer diagnostic tools were not commonly used. Evidence-based optometric care for dry eye management should be encouraged in Hong Kong optometric practice.
PubMed: 38807885
DOI: 10.1016/j.heliyon.2024.e31181 -
BMC Ophthalmology May 2024To investigate the current prescribing patterns for correcting hyperopia among optometrists in clinical practice in Saudi Arabia and compare those to current...
BACKGROUND
To investigate the current prescribing patterns for correcting hyperopia among optometrists in clinical practice in Saudi Arabia and compare those to current international guidelines. And explore the factors that influence practitioners' prescribing decision.
METHOD
This cross-sectional study employed 30 items online survey that encompass demographic data, current practice and cycloplegia use, numerical response to indicate the minimum level of hyperopia at which optometrists would consider prescribing spectacles to non-strabismic children and determine the diopter value required for prescribing correction for hyperopia if present with other factors.
RESULT
A total of 104 optometrists responded to the survey (52 females and 52 males). They recruited from 35 cities across Saudi Arabia. Out of total, 44% of them considered cycloplegic refraction essential under 12 years and 56% of them extended the range to 18 years. Large variation were found between the optometrists' responses and current guideline recommendations. Several factors influenced the decision-making of the practicing optometrist including signs and symptoms, bilateral hyperopia, average dioptric value, reading difficulty, and accommodative function.
CONCLUSION
There are some matches between the international guidelines and the practice patterns that followed by optometrists in Saudi Arabia, however, the optometrists did not report that they are following them purposefully. These findings highlight the need to improve optometrists' practice about spectacle prescription in pediatric population.
Topics: Humans; Hyperopia; Male; Female; Cross-Sectional Studies; Optometrists; Saudi Arabia; Practice Patterns, Physicians'; Adult; Child; Prescriptions; Eyeglasses; Adolescent; Middle Aged; Young Adult; Child, Preschool; Surveys and Questionnaires; Refraction, Ocular; Optometry
PubMed: 38807053
DOI: 10.1186/s12886-024-03496-5