Community Optometric Practice Research Articles

Teleophthalmology-Enabled Direct Vitreoretinal Surgery Listing from Community Optometric Practice: Enhanced Efficiency During Coronavirus Disease 2019, and Beyond?

Purpose: To share a method of appropriately connecting patients directly to tertiary ophthalmology centers where subspecialist vitreoretinal (VR) surgical management is required during coronavirus disease 2019 (COVID-19). Methodology: We present our experience of a live teleophthalmology link directly connecting an optometrist to tertiary center VR team at the point of retinal detachment presentation within the community. Results: After the COVID-19 lockdown in National Health Service Forth Valley, Emergency Eye Care Treatment Centers have been set up where optometrists are the first point of contact for patients in the community. Live teleophthalmology link has enabled the optometrist in the community to connect directly with local ophthalmologists. From March 23 to June 15, 2020, five referrals were taken for a suspected retinal detachment, and one for submacular hemorrhage. From the receiving ophthalmologists' viewpoint, satisfaction for the quality of sound, video, and connection was 5/5 in all cases on a 5-point Likert grading; from the referring optometrists' viewpoint mean 4.6/5 for sound and video satisfaction, and 5/5 rating in all cases for connection reliability. On 5/6 occasions (83%) the receiving ophthalmologist connected directly with a VR surgeon in a tertiary center. Four-way communication between the patient, optometrist, receiving ophthalmologist, and VR surgeon enabled all five patients to be listed directly for VR surgery from the community, avoiding local ophthalmology department contact during the COVID-19 pandemic. Conclusion: Overall satisfaction and recommendation to others was rated 5/5 in all instances on a 5-point Likert grading, from the patient, optometrist, and ophthalmologist viewpoint.

Confocal infrared imaging with optical coherence tomography provides superior detection of a number of common macular lesions compared to colour fundus photography.

To compare diagnostic accuracy of confocal infrared reflectance (IR), with and without optical coherence tomography (OCT), to colour fundus photography (CFP) in the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) Study. Cross-sectional observational study of participants in NICOLA. CFP, IR and IR/OCT of 640 eyes were graded for hard, soft and reticular pseudodrusen; geographic atrophy; choroidal neovascularisation; naevus; epiretinal membrane; and haemorrhages. Test characteristics (sensitivity and specificity) for each imaging modality with respect to each retinal feature were calculated. With CFP as the reference standard, sensitivity of IR by itself ranged from 75% for RPD to 93.5% for hard drusen and specificity was above 90% for all features except hard drusen (71.7%). For IR combined with OCT, sensitivity ranged from 80% for choroidal neovascularisation to 96.5% for hard drusen. When IR alone was the reference standard, CFP sensitivity was high for naevi (97.5%) but reduced markedly for epiretinal membrane (48.5%). When the combination of IR and OCT was the reference standard, sensitivity for CFP was least for epiretinal membrane (31.5%), low for geographic atrophy and reticular pseudodrusen (77.8% and 76.2% respectively) and high for all other lesion types. Our findings support the use of confocal IR with OCT as a screening tool for a variety of features of macular disease in community optometric practice.

Trigeminal neuralgia and contact lens wear at a community optometric practice: A case report

Trigeminal neuralgia and contact lens wear at a community optometric practice: A case report

Expanding the traditional role of optometry: Current practice patterns and attitudes to enhanced glaucoma services in Ireland

PurposeTo investigate current diagnostic equipment availability and usage for glaucoma case-finding within community optometric practice, and to explore optometrists’ attitudes towards an enhanced scope of clinical practice. MethodsAn anonymous survey was developed, validated, and distributed to all optometrists in Ireland. Results199 optometrists (27% of registrants) responded to the survey. 87% had access to the traditional triad of tests necessary to conduct adequate glaucoma case finding. Standard automated perimetry was the most commonly absent (13%) of the three essential screening tests. 64% of respondents indicated that monocular direct ophthalmoscopy was their first choice technique for fundus examination. 47% of respondents had access to contact applanation tonometry, though just 14% used it as first choice during routine eye examinations. Among the 73 participants with access to both contact and non-contact tonometry (NCT), 80.8%, used NCT preferentially. The significant majority (98%) indicated an interest in enhanced glaucoma services with 57% agreeing that postgraduate training was an essential prerequisite to any increase in scope of practice. ConclusionIrish optometrists are well equipped with the traditional tests used in glaucoma detection. However, implementation of enhanced referral schemes or glaucoma monitoring or management services would require equipment upgrades and associated training in at least half of the surveyed practices. There is strong interest in furthering optometric professional development and expanding the traditional role boundaries of optometrists, incorporating further education as an essential prerequisite to an enhanced scope of practice.

A pilot study of the feasibility of delivering a brief smoking cessation intervention in community optometric practice

A pilot study of the feasibility of delivering a brief smoking cessation intervention in community optometric practice

A survey of current and anticipated use of standard and specialist equipment by UK optometrists.

To investigate current and anticipated use of equipment and information technology (IT) in community optometric practice in the UK, and to elicit optometrists' views on adoption of specialist equipment and IT. An anonymous online questionnaire was developed, covering use of standard and specialist diagnostic equipment, and IT. The survey was distributed to a random sample of 1300 UK College of Optometrists members. Four hundred and thirty-two responses were received (response rate=35%). Enhanced (locally commissioned) or additional/separately contracted services were provided by 73% of respondents. Services included glaucoma repeat measures (30% of respondents), glaucoma referral refinement (22%), fast-track referral for wet age-related macular degeneration (48%), and direct cataract referral (40%). Most respondents (88%) reported using non-contact/pneumo tonometry for intra-ocular pressure measurement, with 81% using Goldmann or Perkins tonometry. The most widely used item of specialist equipment was the fundus camera (74% of respondents). Optical Coherence Tomography (OCT) was used by 15% of respondents, up from 2% in 2007. Notably, 43% of those anticipating purchasing specialist equipment in the next 12months planned to buy an OCT. 'Paperless' records were used by 39% of respondents, and almost 80% of practices used an electronic patient record/practice management system. Variations in responses between parts of the UK reflect differences in the provision of the General Ophthalmic Services contract or community enhanced services. There was general agreement that specialised equipment enhances clinical care, permits increased involvement in enhanced services, promotes the practice and can be used as a defence in clinico-legal cases, but initial costs and ongoing maintenance can be a financial burden. Respondents generally agreed that IT facilitates administrative flow and secure exchange of health information, and promotes a state-of-the-art practice image. However, use of IT may not save examination time; its dynamic nature necessitates frequent updates and technical support; the need for adequate training is an issue; and security of data is also a concern. UK optometrists increasingly employ modern equipment and IT services to enhance patient care and for practice management. While the clinical benefits of specialist equipment and IT are appreciated, questions remain as to whether the investment is cost-effective, and how specialist equipment and IT may be used to best advantage in community optometric practice.

Investigation of the causes of non-tolerance to optometric prescriptions for spectacles

To study non-tolerance to spectacle prescriptions in a busy community optometric practice, with several practitioners. A spectacle non-tolerance was defined in a pragmatic way, as a patient who had collected spectacles from the practice and subsequently returned because they were either having problems with, or were unable to wear, their new spectacles. Patients over 16 years of age, who met the above definition of non-tolerance were sequentially recruited over a 6 month period. Patients experiencing adaptation problems were first seen by a dispensing optician and any dispensing issues resolved. If the spectacle dispensing was felt to be correct, or if the non-tolerance persisted, then the patient was re-examined by an optometrist and the results analysed. Non-tolerance examinations accounted for 62 of the 3091 eye examinations during the study period. The average rate of non-tolerance, averaged across the practitioners, was 1.8%, varying from 1.3-3.3% for individual practitioners. Gender was not a factor in non-tolerance, however age was, with presbyopes accounting for 88.1%. The most common reasons for non-tolerance were, in order of decreasing frequency: prescription related (61.0%), dispensing related (22.0%), pathology (8.5%), data entry error (6.8%) and binocular vision anomalies (1.7%). Of prescription related errors, gauging the spherical element accounted for the majority of inaccuracies, followed by problems with the near/intermediate addition. In every case, the final prescription was within 1.00 D of the not tolerated, prescription; 84.4% were within +/-0.50 D. Spectacle prescription non-tolerance forms a small, but important, form of adverse reaction in optometric clinics. Most non-tolerances can be resolved by small changes, within 0.50 D, to the prescription.

Peripapillary retinal nerve fibre layer thickness in highly myopic Caucasians as measured by Stratus optical coherence tomography

Aims:To assess peripapillary retinal nerve fibre layer (RNFL) thickness distribution in a group of non-glaucomatous Caucasian subjects with a high degree of myopia and to evaluate the relationship between RNFL...

The Mallett Fixation Disparity Test: influence of test instructions and relationship with symptoms

Fixation disparity is a minute ocular misalignment under conditions of binocular single vision and is typically detected in primary eye care practices in the UK using the Mallett Unit Fixation Disparity Test. This instrument creates natural viewing conditions, when the patient's binocular system is fused using both central and peripheral fusion locks. This allows the examiner to determine the minimum prism power that eliminates the fixation disparity: the associated phoria or aligning prism. The spherical power that eliminates the fixation disparity, the aligning sphere, can also be determined. The near Mallett Unit Fixation Disparity Test has been shown to have good sensitivity and specificity for detecting symptomatic heterophoria. Cases of decompensated heterophoria tend to have a fixation disparity and the aligning prism or aligning sphere is a good indicator of the correction that will render the heterophoria compensated. The purpose of this study was, for the first time, to investigate the effect of test instructions on the results of the Mallett Unit Fixation Disparity Test. In study 1, we surveyed and observed practitioners to determine the instructions that are typically used. In study 2, we compared results obtained with this "standard" method of questioning with a more "specific" form of questioning that has been suggested in the literature. The participants for study 2 were 105 patients aged 7-70 years who were randomly selected from those attending a community optometric practice. Significantly different results were obtained with the two sets of instructions. The specific form of questioning revealed more cases of fixation disparity and the results with this method showed a better correlation with symptoms. This only held for near vision: for distance vision, symptoms were not significantly correlated with the presence of fixation disparity. This agrees with previous work with the Mallett unit, which showed a significant relationship with symptoms only at near. We also found that patients with more severe symptoms had greater degrees of aligning prism. Our study supports previous work indicating that the Mallett unit is a useful tool for detecting symptomatic heterophoria at near. However, we found that the testing method is important: patients need to be asked not just whether the nonius strips are aligned but also whether one or both of the strips ever moves. More research is needed to investigate the significance of precise test instructions in other optometric and orthoptic tests.

Error classification in community optometric practice – a pilot project

A pilot study was conducted to undertake a baseline assessment of errors reported in community optometric practice. The feasibility and acceptability of a method for recording staff-reported errors in optometric community practice was investigated. An anonymous self-reporting system was introduced in order to collect information regarding errors/untoward events in community optometric practice. UK community optometric practice. Classification of errors according to a previously published study pertaining to general medical practice in the same geographical area. Thirty-six notebooks were distributed to 10 participating community optometric practices. At the end of the 1 month study period the note books were returned and the 439 entries made were classified into seven categories: optical prescriptions (18.2%), communication (35.5%), administrative (15%), appointments (2.3%), equipment (11.9%), clinical (10.3%) and other (6.9%). A previously developed classification of errors in general medical practice was found to be equally applicable to community optometric practice. This study forms the basis of providing an acceptable and practical methodology, which can be applied by Primary Care Trusts (PCTs) when developing their risk management strategy to include optometry.