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JAMA Ophthalmology Jun 2022The association between availability of eye care clinicians and visual impairment, a condition presenting with increased morbidity and health care costs, has not been...
IMPORTANCE
The association between availability of eye care clinicians and visual impairment, a condition presenting with increased morbidity and health care costs, has not been thoroughly studied.
OBJECTIVE
To examine associations between the geographic distribution of eye care clinicians and visual impairment in California.
DESIGN, SETTING, AND PARTICIPANTS
This survey-based cross-sectional study included ophthalmologists and optometrists licensed in California in 2018 and 2020 as well as respondents to the 2014 to 2018 American Community Survey (ACS) by California counties and Medical Service Study Areas (MSSAs). Data were analyzed from August 2020 to December 2021.
MAIN OUTCOMES AND MEASURES
Prevalence of visual impairment by county and MSSA.
EXPOSURES
The number of eye care clinicians was determined based on the number of member ophthalmologists of the American Academy of Ophthalmology in 2018 and optometrists listed in the 2020 Blue Book of Optometrists in California. The prevalence of visual impairment was determined using questionnaire data from the American Community Survey. Linear regression was used to assess multivariable associations between number of eye care clinicians and visual impairment by MSSA.
RESULTS
A total of 30 068 581 California residents were included; 15 253 655 (50.7%) were female, and 5 314 389 (17.7%) were 65 years and older. The overall number of eye care clinicians was 22.18 clinicians per 100 000 residents. The overall prevalence of visual impairment was 2411.07 residents with visual impairment per 100 000 residents. San Francisco County had the highest number of eye care clinicians per 100 000 residents (39.24 clinicians per 100 000 residents). Four counties had no eye care clinicians (Alpine, Mariposa, Inyo, and Sierra counties). For every increase of 1 eye care clinician per 100 000 residents, there was a mean (SE) decrease of 3.90 (1.39) persons with visual impairment per 100 000 residents in adjusted analyses.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study, a higher number of eye care clinicians was potentially associated with lower prevalence of visual impairment in California. Additional studies are needed to assess eye care clinician availability on a national and global scale and strategies to improve access to eye care.
Topics: Cross-Sectional Studies; Female; Health Services Accessibility; Humans; Male; Ophthalmologists; Optometrists; United States; Vision, Low
PubMed: 35511131
DOI: 10.1001/jamaophthalmol.2022.1001 -
Irish Journal of Medical Science Feb 2023Brolucizumab is a novel humanised, single-chain, variable fragment inhibitor of Vascular Endothelial Growth Factor-A for the treatment of neurovascular age-related... (Review)
Review
Brolucizumab is a novel humanised, single-chain, variable fragment inhibitor of Vascular Endothelial Growth Factor-A for the treatment of neurovascular age-related macular degeneration. Brolucizumab gained US Food and Drug Administration and European Medicines Agency approval following the Phase III HAWK (NCT02307682) and HARRIER (NCT02434328) trials which compared brolucizumab with aflibercept, presenting a tolerable safety and favourable efficacy profile. The mean change (least squares [LS] mean ± standard error) in best-corrected visual acuity letters from baseline to week 96 in the HAWK trial was 5.9 ± 0.78 for brolucizumab (6 mg) versus 5.3 ± 0.78 for aflibercept, and in the HARRIER trial, 6.1 ± 0.73 (6 mg) for brolucizumab (6 mg) and 6.6 ± 0.73 for aflibercept. Within both trials, greater reductions were noted in the central subfield thickness from baseline to week 96 in the brolucizumab (6 mg) groups versus the aflibercept group. Subsequent post-marketing reports detailed intraocular inflammation (IOI) after brolucizumab treatment and in response an independent safety review committee conducted a post hoc data review. While comparable, the rate of brolucizumab-associated IOI was higher in the post hoc analysis than the trials (4.6% and 4.4%, respectively). Findings from trials and real-world data indicate there may be pre-defining risk factors that predispose patients to IOI following brolucizumab treatment. With a thorough understanding of IOI classification and best practice management, ophthalmologists can use brolucizumab confidently and, should a case arise, they should act quickly to prevent vision loss. Herein, we provide information and guidance to support clinical decision-making related to brolucizumab use.
Topics: Humans; Vascular Endothelial Growth Factor A; Angiogenesis Inhibitors; Ophthalmologists; Antibodies, Monoclonal, Humanized
PubMed: 35102497
DOI: 10.1007/s11845-022-02929-8 -
Asia-Pacific Journal of Ophthalmology... 2019Participation in continuing professional development (CPD) is part of lifelong learning required by ophthalmologists. Metacognition is a new area of educational... (Review)
Review
Participation in continuing professional development (CPD) is part of lifelong learning required by ophthalmologists. Metacognition is a new area of educational research. It is important because metacognitive skills are essential in medical education and likely to improve effectiveness of CPD activities. We systematically searched PubMed using the terms "metacognition" and "CPD" or "continuing medical education (CME)" and found only 5 articles. These articles were supplemented by a broadbased review of published literature including educational psychology, across the continuum of medical education. We summarize the techniques that may improve metacognition in CPD: awareness of and instruction in metacognition, awareness and mitigation of cognitive errors, appropriate needs analysis, and choosing appropriate activities. Metacognition and learning of new surgical techniques, the role of portfolios, and the role of the educator are described. The evidence is weak however, and it is usually extrapolated to CPD activities from other fields. Ophthalmologists may be able to improve their metacognitive skills in the CPD context, but the evidence supporting this is of low quality.
Topics: Education, Medical, Continuing; Guidelines as Topic; Humans; Learning; Metacognition; Ophthalmologic Surgical Procedures; Ophthalmologists; Ophthalmology
PubMed: 30596228
DOI: 10.22608/APO.2018280 -
BMJ Open Jul 2021Cataract surgery is very important to prevent blindness, but its productivity and efficiency in China are unknown. Our study aimed to evaluate the geographical... (Observational Study)
Observational Study
BACKGROUND
Cataract surgery is very important to prevent blindness, but its productivity and efficiency in China are unknown. Our study aimed to evaluate the geographical distribution of cataract surgeons and prospectively identify the factors associated with the increased productivity in cataract surgery and efficiency in outpatient ophthalmic services in rural Chinese hospitals.
METHODS
Data were prospectively collated from various hospital datasets and the census registered by the geographical unit county. Prior to mapping, the geographical location data of counties were cross-linked with the equivalent ophthalmologist and service output data to create categories and map multiple data attributes. Descriptive statistical analyses were performed to characterise the data stratified by county. Linear regression analyses were used to explore the factors associated with the increased productivity/efficiency.
RESULTS
The ophthalmologists, surgical productivity of ophthalmologists and outpatient efficacy of ophthalmologists significantly varied across counties. During the period between 2016 and 2018, the median (IQR) change in surgical productivity of and outpatient efficacy of ophthalmologists were 31.627 (-3.33 to 29.94) and 118.08 (-132.30 to 740.89). In the simple regression analysis for predictors of a high productivity change, only the increased number of phaco machine had statistical significance (p=0.003). In addition, only the gross domestic product per capita in 2016 was associated with an increased improvement in efficiency of outpatient services (p=0.008).
CONCLUSIONS
This study demonstrated that the ophthalmologist productivity and the efficiency of outpatient services were unequally geographically distributed, and their predictors were identified. Further studies to elucidate the extent of the problem and improve the health service delivery models are required.
Topics: Cataract Extraction; China; Hospitals, County; Humans; Ophthalmologists; Ophthalmology
PubMed: 34215595
DOI: 10.1136/bmjopen-2020-042326 -
The British Journal of Ophthalmology Apr 2020To estimate 2015 global ophthalmologist data and analyse their relationship to income groups, prevalence rates of blindness and visual impairment and gross domestic...
BACKGROUND/AIMS
To estimate 2015 global ophthalmologist data and analyse their relationship to income groups, prevalence rates of blindness and visual impairment and gross domestic product (GDP) per capita.
METHODS
Online surveys were emailed to presidents/chairpersons of national societies of ophthalmology and Ministry of Health representatives from all 194 countries to capture the number and density (per million population) of ophthalmologists, the number/density performing cataract surgery and refraction, and annual ophthalmologist population growth trends. Correlations between these data and income group, GDP per capita and prevalence rates of blindness and visual impairment were analysed.
RESULTS
In 2015, there were an estimated 232 866 ophthalmologists in 194 countries. Income was positively associated with ophthalmologist density (a mean 3.7 per million population in low-income countries vs a mean 76.2 in high-income countries). Most countries reported positive growth (94/156; 60.3%). There was a weak, inverse correlation between the prevalence of blindness and the ophthalmologist density. There were weak, positive correlations between the density of ophthalmologists performing cataract surgery and GDP per capita and the prevalence of blindness, as well as between GDP per capita and the density of ophthalmologists doing refractions.
CONCLUSIONS
Although the estimated global ophthalmologist workforce appears to be growing, the appropriate distribution of the eye care workforce and the development of comprehensive eye care delivery systems are needed to ensure that eye care needs are universally met.
Topics: Female; Global Health; Health Personnel; Health Services Needs and Demand; Health Services Research; Health Surveys; Health Workforce; Humans; Income; International Agencies; Male; Ophthalmologists; Ophthalmology; Societies, Medical; Surveys and Questionnaires
PubMed: 31266774
DOI: 10.1136/bjophthalmol-2019-314336 -
Middle East African Journal of... 2022The purpose of this study was to address disparities between male and female Iraqi ophthalmologists in terms of personal circumstances, professional profiles, and...
PURPOSE
The purpose of this study was to address disparities between male and female Iraqi ophthalmologists in terms of personal circumstances, professional profiles, and attitudes toward work and family life.
METHODS
A Google Form-based questionnaire was released on a social media platform including 500 ophthalmologists between September 1, and December 1, 2021. The survey included three domains: (1) demographic characteristics, (2) clinical practice profile, and (3) career satisfaction and work/family balance.
RESULTS
The study included a total of 209 specialists, with a response rate of 45.5%. About 69.4% of them were 45 years and younger. The female-to-male ratio was 1:1.6, 188 (90%) were married and 186 (88.9%) had children. Women ophthalmologists worked fewer hours, days, and operations than male ophthalmologists ( = 0.091). Moreover, women ophthalmologists in private practice were considerably underrepresented. General ophthalmologists represented 77%. The number of women ophthalmologists with subspecialty degrees was far less 9 (11.5%) than males 38 (29.2%), = 0.003, and they performed significantly fewer operations than male ophthalmologists ( = 0.001). Family duties were the biggest deterrent for female ophthalmologists. For males, the private clinic is an obstacle to acquiring a specialty degree in 45.6%, but for women, it is just 25.7%. Overall satisfaction was 65.1%. Women respondents were less satisfied with their practice ( = 0.009) and thought that they are facing more challenges (0.007). Men believed they had less time to spend with family, implying that women sacrifice working time/income to satisfy family obligations and expectations. Work-life balance is achieved by limiting work hours and including family members.
CONCLUSION
Women ophthalmologists in Iraq might be facing greater obstacles to their professional advancement than their male counterparts. Female doctors were working fewer hours and doing fewer surgical procedures, and they were less likely to pursue subspecialty certification.
Topics: Child; Humans; Male; Female; Ophthalmologists; Iraq; Physicians, Women; Job Satisfaction; Surveys and Questionnaires
PubMed: 37123428
DOI: 10.4103/meajo.meajo_87_22 -
BMJ Open Jul 2022Globally, diabetic retinopathy (DR) is the leading cause of blindness in working-aged adults. Early detection and treatment of DR is essential for preventing sight loss....
INTRODUCTION
Globally, diabetic retinopathy (DR) is the leading cause of blindness in working-aged adults. Early detection and treatment of DR is essential for preventing sight loss. Services must be available, accessible and acceptable to patients if we are to ensure they seek such care.
OBJECTIVES
To understand patients' knowledge and attitudes towards laser versus antivascular endothelial growth factor (VEGF) injections to treat DR in Vietnam, and to identify factors Vietnamese ophthalmologists consider when making treatment decisions.
METHODS
This is a descriptive qualitative study based on semi-structured interviews with 18 patients (12 from Ho Chi Minh City and 6 from Hanoi) plus individual interviews with 24 ophthalmologists working in eye clinics in these cities. Thematic analysis was used to analyse the data.
RESULTS
In total, 10/24 (41.7%) ophthalmologists were female, and their median age was 41 years (range 29-69 years). The median age of patients was 56.5 years (range 28-72 years), and 7/18 (38.9%) were female. Briefly, factors that influence DR treatment decisions for ophthalmologists are medical considerations (ie, severity of disease, benefits and risks), availability (ie, treatment and resources) and patient-related factors (ie, costs and adherence). Patient's perceived barriers and facilitators to treatments were based on patient and family related factors (ie, treatment and transportation costs) and previous treatment experiences (ie, positive and negative). Recommendations by all participants included ensuring that both laser and anti-VEGF injections are widely available across the country and controlling costs for patients and the healthcare system.
CONCLUSIONS
Reducing DR treatment costs, optimising treatments options, and expanding the network of clinics offering treatment outside metropolitan areas were the main issues raised by participants. These findings can help inform policy changes in Vietnam and may be generalisable to other low-resource settings.
Topics: Adult; Aged; Blindness; Diabetes Mellitus; Diabetic Retinopathy; Female; Humans; Macular Degeneration; Male; Middle Aged; Ophthalmologists; Qualitative Research; Vietnam
PubMed: 35798521
DOI: 10.1136/bmjopen-2021-055061 -
Arquivos Brasileiros de Oftalmologia 2016
Topics: Autistic Disorder; Child; Diagnosis, Differential; Humans; Ophthalmologists; Physician's Role; Vision Disorders
PubMed: 28076558
DOI: 10.5935/0004-2749.20160101 -
Ophthalmology Sep 2020
Topics: Biomedical Research; COVID-19; Disease Transmission, Infectious; Humans; Information Dissemination; Intersectoral Collaboration; Ophthalmologists; Ophthalmology; Practice Patterns, Physicians'; SARS-CoV-2; Social Media
PubMed: 32502595
DOI: 10.1016/j.ophtha.2020.05.048 -
Ophthalmology Nov 2019
Topics: Artificial Intelligence; Biomedical Research; Eye Diseases; Humans; Image Processing, Computer-Assisted; Neural Networks, Computer; Ophthalmologists; Peer Review, Research; Reference Standards
PubMed: 31635697
DOI: 10.1016/j.ophtha.2019.09.014