Eye Care Providers Research Articles

Perspectives of carriers of X-linked retinal diseases on genetic testing and gene therapy: A global survey.

Female carriers of X-linked inherited retinal diseases (IRDs) are burdened with potentially passing their disease-causing variant to future generations, as well as exhibiting signs of retinal disease themselves. This study aimed to investigate carriers' experiences of genetic testing, emotions relating to having affected children, and their knowledge regarding genetic testing and gene therapy. An online survey was advertised to self-identified carriers worldwide. Two hundred and twenty-eight carriers completed the survey with mean age of 51 years (SD ± 15.0). A majority of respondents resided in the United States of America (51%), Australia (19%), and the United Kingdom (14%). Most carriers identified with feelings of guilt (70%), concern (91%), and anxiety (88%) for their child. Female carriers who had given birth to children had significantly greater gene therapy knowledge compared to carriers who had not (p < 0.05). Respondents agreed that their eyecare provider and general practitioner helped them understand their condition (63%), however, few carriers reported receiving psychological counselling (9%) or family planning advice (5%). Most respondents (78%) agreed that gene therapy should be available to carriers. This study emphasises the importance of providing appropriate counselling to female carriers and illustrates the motivation of many to participate in emerging treatment options, such as gene therapy.

Case Report: Branch Retinal Vein Occlusion Post mRNA SARS-CoV-2 (COVID-19) Vaccination.

Systemic thromboembolic complications are well documented to be associated with Coronavirus disease 2019 (COVID-19), however, there has been a growing number of reports regarding ocular complications stemming from COVID-19 vaccinations. This case illustrates a clear temporal and possible causal relationship of COVID-19 vaccination with an ocular microvascular disorder, namely retinal vein occlusion. To report a case of inferotemporal branch retinal vein occlusion after mRNA SARS-CoV-2 vaccination. A middle-aged female developed right eye central scotoma two days after COVID-19 vaccination. She had transient hypertension during the first two days post-vaccination. A decrease in visual acuity (6/18) was documented. Initial retinal findings included flame-shaped hemorrhages and cotton wool spots along inferotemporal branch retinal vessels. Optical coherence tomography revealed right eye cystoid macular edema. Laboratory investigation revealed mildly raised erythrocyte sedimentation rate and C-reactive protein. Other systemic examinations were unremarkable. She was treated for right eye inferotemporal branch retinal vein occlusion with cystoid macular edema and was given intravitreal anti-vascular endothelial growth factor monthly in three doses. Her visual acuity improved to 6/6 with resolved cystoid macular edema. This case illustrates a clear temporal and possible causal relationship between COVID-19 vaccination and retinal vein occlusion. Post vaccination transient hypertension, or the immunological and inflammatory response to the vaccine may have contributed to the venous occlusive event in this case. Eye care providers should remain aware of this possibility. The effectiveness of intravitreal anti-vascular endothelial growth for the treatment of macular edema secondary to branch retinal vein occlusion was demonstrated in this patient.

Access to Eye Care Providers and Glaucoma Severity in the National Institutes of Health All of Us Research Program.

In the "All of Us (AoU) Research Program," individuals with access to vision care were more likely to have mild, moderate, or severe glaucoma and undergo incisional surgery compared with those without vision care access. To examine the associations between access to eye care, glaucoma severity, and incisional glaucoma surgery using data from the National Institute of Health AoU Research Program. Individuals with International Classification of Diseases Ninth or 10th Revision codes and who answered the survey question about eye care access in AoU were included in the study. The exposure variable was access to eye care services, with outcome variables (1) glaucoma severitys and (2) likelihood of incisional surgery. Unadjusted multinomial logistic regression compared access to eye care services and glaucoma severity. In addition, unadjusted logistic regression models compared access to eye care and the likelihood of incisional surgery. These were repeated using adjusted analyses, controlling for sex assigned at birth, race and ethnicity, and age. Compared with individuals without access to eye care services, those with access were more likely to have all levels of glaucoma severity [mild adjusted odds ratio (aOR): 5.81, 95% CI: 3.15-10.73, moderate aOR: 4.44, 95% CI: 2.45-8.02, severe aOR: 6.95, 95% CI: 2.69-17.93, and unspecified aOR: 3.06, 95% CI: 2.72, 3.45]. Access to eye care was associated with increased odds of any incisional glaucoma surgery (aOR: 3.00, 95% CI: 1.24-9.90) and of trabeculectomy (aOR: 3.30, 95% CI: 1.02-20.28) but not of tube shunt procedures (aOR: 2.65, 95% CI: 0.80-16.38). This study demonstrated that access to eye care services was associated with a higher prevalence of all levels of glaucoma severity; those with access to eye care services were more likely to undergo incisional surgery than those without access. Future research should focus on methods to best encourage eye care to limit glaucoma progression.

Cost-Effectiveness Analysis of a Regional Program for Identifying and Treating Children with Correctable Refractive Error in Indonesia

ABSTRACT Purpose Indonesia is a rapidly growing county with over 262 million inhabitants, but among highly populated countries it has one of the lowest concentrations of eye care providers. This study evaluated the cost-effectiveness of a program implemented in South Sulawesi, Indonesia that trained school teachers to conduct vision screenings, organized in-school evaluations by opticians, and provided free eyeglasses to school children with refractive error (RE). Methods Schoolteachers across 6 districts in South Sulawesi were trained to screen children with possible RE for subsequent evaluation by opticians. All costs associated with designing and implementing the program (administration, training personnel, labor, service delivery, etc.) were assessed. Expenditures and outcomes data were utilized to calculate the cost per disability-adjusted-life-year (DALY) averted using both 2010 and 2016 Global Burden of Disease (GBD) weights. Results 521 teachers screened 41,212 students across 172 schools in South Sulawesi. 4,506 (10.9%) students failed screening, 2,652 were seen by optometrists, and 2,038 received glasses. The total program cost was US$97,380, with glasses (39.6%) and labor (23.3%) accounting for the two biggest expenditures. In districts with school-based refraction services, the costs per student screened, refracted, and receiving glasses were $2.57, $31.33, and $41.40, respectively; costs were $2.04, $59.80, and $73.22 when district services were instead provided centrally. The estimated cost per DALY averted was US$89.04 based on GBD 2010 weights. Conclusion Treating children with correctable RE in limited resource settings can be done cost-effectively through a school-based model.

Causes of Visual Impairment and Types of Low Vision Aids Prescribed in Low Vision Clinic, Sibu Hospital, Sarawak

This study was to determine the causes of visual impairment and to identify the low vision prescribing pattern among Low Vision Clinic (LVC) patients in the Sibu Hospital. This study was conducted retrospectively among 41 patients attending the LVC, Sibu Hospital. Patients’ demographic characteristics, causes of low vision and blindness, and types of low vision devices prescribed were recorded and analysed for 21 (52.5%) males and 19 (47.5%) females. The mean age was 39.38 ± 17.98 years. The main causes of visual impairment were retinal dystrophies in 12 cases (30.0%) followed by neurological causes in 9 cases (22.5%), glaucoma in 8 cases (20.0%), and acquired macular disorders in 4 cases (10.0%). A total of 27 low vision devices were dispensed, 85.2% (n = 23) were near devices and 14.8% (n = 4) were distance devices. The most frequently prescribed low vision devices (LVD) were video magnifiers (37.0%), followed by hand magnifiers (22.2%), spectacle magnifiers (14.8%), telescopes (14.8%) and stand magnifiers (11.1%). The main leading causes of visual impairment in LVC Sibu Hospital were retinal dystrophies. Video magnifiers were the most common type of low-vision device prescribed. A prompt comprehensive screening is urged for family members with retinal dystrophies to detect the diseases early and hence timely exposure to low vision care and rehabilitation. Familial counselling on inherited retinal diseases and better screening by primary eye care providers are required. Low vision services should be an integral part of the eye care systems in Malaysia.

Trends and practices following the 2016 hydroxychloroquine screening guidelines

This study aimed to understand the profile of hydroxychloroquine-treated patients, referral patterns, and dosing and to assess the adherence of eye care providers to the latest 2016 screening guidelines provided by the American Academy of Ophthalmology. Patients were identified using electronic health records (EHR) taking hydroxychloroquine and were seen by optometrists, retinal specialists, and non-retinal ophthalmologists. Review of EHR data includes demographic characteristics, indications, and dosing profile of hydroxychloroquine use, eye care provider managing the patient, and imaging modalities performed. A total of 166 patients were included in the study. The most common indications for screening were systemic lupus erythematosus and discoid lupus (52.4%) followed by rheumatoid arthritis (18.7%) and Sjögren’s syndrome (9.6%). Ninety-two (55.4%) patients were on a higher-than-recommended dose of > 5 mg/kg/day. Patients who weighed less (mean 63.9 kg) were taking a higher-than-recommended dose (vs. 81.5 kg, p < 0.001). Although retinal specialists adhered best to the use of all three recommended imaging modalities, visual field testing was done appropriately for only 8.3% of Asian and 71.1% of non-Asian patients. In conclusion, there is substantial variability in screening by ophthalmic providers and prescribing practices compared with the current recommendations. In particular, there is a marked deficiency in correct visual field testing in Asian patients. These findings are important to highlight potential interventions to improve screening for hydroxychloroquine toxicity.

Eye care in Cambodia

Dr Scott Mackie reflects on a visit to Cambodia to provide eye care for children

Social and Health Care Utilization Factors Associated With Ophthalmic Visit Nonadherence in Glaucoma: An All of Us Study.

In a diverse nationwide cohort, lower education and income levels, cost saving on medications, fewer past-year medical/specialist visits, and concerns regarding dissimilarity with health care providers were risk factors for ophthalmic visit nonadherence among glaucoma patients. The purpose of this study was to characterize social and health care utilization factors associated with nonadherence with ophthalmic visits among patients with glaucoma. Glaucoma patients in the All of Us database who completed the Healthcare Access and Utilization Survey were included and categorized into "visit" and "nonvisit" groups based on visit adherence, defined by self-reported past-year encounters with eyecare providers (yes/no). Data regarding potential factors affecting ophthalmic visit adherence, including past-year medical visits, inabilities to afford health care, and self-reported reasons for delayed care, were extracted. χ 2 tests and logistic regression were used to compare the 2 groups. Odds ratios (ORs) of visit adherence were analyzed for potential risk factors. Of 5739 glaucoma patients, 861 (15%) were in the nonvisit group. More participants in the visit group reported past-year general doctor/specialist visits (94%/65%; vs. nonvisit group: 89%/49.3%; P <0.05). The nonvisit group reported greater difficulty in affording medical care and learning about medical conditions, and higher rates of delayed/missed health care access for various concerns ( P <0.05). Older age (OR=1.02, 1.01-1.03), higher education (OR=1.25, 1.13-1.40), and income level (OR=1.06, 1.01-1.11), not employed for wages (OR=1.28, 1.08-1.53), and higher health care utilization in general medical/specialist visits (ORs range:1.08-1.90) were associated with visit adherence ( P <0.05). Visit nonadherence was associated with cost saving on medication (OR=0.62, 0.40-0.97) and delaying/avoiding seeing health care providers because of dissimilarity (OR=0.84, 0.71-0.99) ( P <0.05). This study builds on prior literature by identifying potentially modifiable factors associated with visit nonadherence and underutilization of eyecare in glaucoma. These may inform strategies to improve real-world ophthalmic visit adherence and identify patients who might benefit from additional support.

Knowledge, attitude, perception and education on contact lenses for refractive errors in Kenya

Background: Globally, contact lenses are an important part of the management process for refractive errors. Contact lenses are accepted widely in developed countries, but they are currently less used in developing countries like Kenya.Aim: To assess the knowledge, attitudes and perceptions (KAP) (both pre- and post-education) to contact lens uptake specifically for correction of refractive errors by patients attending a Kenyan University Eye Clinic.Setting: Academic Vision Centre, Masinde Muliro University of Science and Technology, Kakamega, Kenya.Methods: A quasi-experimental cross-sectional study was performed by reviewing all records from February 2014 to March 2020; 360 records were purposively selected. Thereafter, a structured questionnaire with educative content on contact lenses was administered by phone and online to determine KAP. Responses were collected over a period of one month. Knowledge, attitudes and perceptions were categorised and scored, and descriptive statistics and paired t-tests were used for data analysis.Results: More women (58.3%) and mostly students (59.2%) participated, with ages from 16 to 38 years (mean age and standard deviation of 22.85 ± 4.32). Overall, there was poor knowledge of contact lenses for refractive errors (96.7%). Attitudes to contact lenses were unfavourable, both pre- and post-education (94.7% and 92.8%). Perceptions of contact lens uptake were negative pre-education (92.5%) but positive post-education (95.3%).Conclusion: Education changed perceptions of contact lens usage for refractive errors correction, but even with some focused education, negative attitudes and poor knowledge regarding contact lenses persisted in the sample. Practitioners should inform patients about contact lenses as a possibility for refractive error management, and institutions training eye care providers should consolidate their clinical teaching regarding contact lenses.Contribution: This study showed that the more people with refractive errors are knowledgeable about contact lenses, the more uptake of contact lenses will happen, optometrists and ophthalmologists should educate people more on contact lenses.

Factors Associated with Utilization of Teleretinal Imaging in a Hospital-Based Primary Care Setting.

Regular eye examinations to screen for the initial signs of diabetic retinopathy (DR) are crucial for preventing vision loss. Teleretinal imaging (TRI) offered in a primary care setting provides a means to improve adherence to DR screening, particularly for patients who face challenges in visiting eye care providers regularly. The present study evaluates the utilization of TRI to screen for DR in an outpatient, hospital-based primary care clinic. Patients with diabetes mellitus (DM) but without DR were eligible for point-of-care screening facilitated by their primary care provider, utilizing a non-mydriatic, handheld fundus camera. Patient demographics and clinical characteristics were extracted from the electronic medical record. Patients who underwent TRI were more likely to be male, non-White, and have up-to-date monitoring and treatment measures, including hemoglobin A1c (HbA1c), microalbumin, and low-density lipoprotein (LDL) levels, in accordance with Healthcare Effectiveness Data and Information Set (HEDIS) guidelines. Our findings demonstrate that TRI can reduce screening costs compared to a strategy where all patients are referred for in-person eye examinations. A net present value (NPV) analysis indicates that a screening site reaches the break-even point of operation within one year if an average of two patients are screened per workday.

A technological approach to "Reaching the Unreached" - Leveraging teleophthalmology services in Rural Gujarat.

Early detection of sight-threatening disorders by technological applications like teleophthalmology and prompt treatment can help decrease visual impairment. This study evaluated the role of teleophthalmology in underserved rural areas along with cost-saving estimates for the end user. A prospective, observational, cross-sectional hospital-based study was conducted over 3 months. First 1000 teleconsultations were included. None of the patients denied providing informed consent. The patients were consulted at the eight vision centers and three satellite centers of the hospital in the nearby rural and tribal regions closer to their residential places. These vision and satellite centers were connected to the base hospital like a hub and spoke model with a teleophthalmology network. Cataract (n = 301, 30.1%) and refractive error (n = 290, 29%) were the most common diagnosis. 42.1% of patients were referred to base hospital for further evaluation. Thus, a total of 57.9% of patients were not required to visit the base hospital for initial consultation, saving time and money. Furthermore, 15.1% of patients were provided medical treatment at the vision center and satellite center, which helped in making teleophthalmology cost-saving for the patients. An average of Rs. 621/- were saved per patient for the community in our study. Networked teleophthalmology model can be an affordable and feasible tool for providing eye care delivery services in rural and tribal regions of Gujarat and the whole country, especially for the end user. Thus, it may be a workable model in ophthalmology practice with substantial cost saving to the community.

Choroidal Nevus Features Associated with Subspecialty Referral

To identify choroidal nevus features associated with referral to a retina or ocular oncology subspecialist. Population-based retrospective cohort study. Patients diagnosed with choroidal nevus. Population-based retrospective cohort study of residents of Olmsted County, Minnesota, with an incident diagnosis of choroidal nevus from January 1, 2006, to December 31, 2015 using the Rochester Epidemiology Project, a medical record linkage system. Tumor features and patient demographics associated with referral to a retina or ocular oncology subspecialist were assessed. Wilcoxon rank sum test, chi-square test, and Fisher exact test were used for statistical analysis. Tumor features and patient demographics associated with referral to subspecialty care. There were 826 incident diagnoses of choroidal nevus, of which 88 cases (11%) were referred, with highest level of referral being retina in 29 cases (33%) and ocular oncology in 59 cases (67%). None of the analyzed demographic features were associated with choroidal nevus referral to subspecialty care. Tumor features associated with referral (vs. not referred) included greater mean basal diameter (4.6 mm vs. 2.4 mm, P<0.001), greater mean tumor thickness (0.7 mm vs. 0.1 mm, P < 0.001), greater distance to optic disc (6.9 mm vs. 3.4 mm, P= 0.02), halo around nevus (5.7% vs. 0.4%, P < 0.001), and drusen on OCT (51% vs. 25%, P=0.002). Presence of orange pigment (8% vs. 0%, P= 0.14), subretinal fluid (9% vs. 2.5%, P= 0.09), and low internal reflectivity on A-scan (7.7% vs. 0%, P= 1.00) were not found more frequently in the subspecialty referral group. Greater basal diameter and mean tumor thickness of choroidal nevus were associated with referral to retina or ocular oncology. However, several features associated with increased risk of malignant transformation were not associated with subspecialty referral. These findings highlight the importance of educating eye care providers about high-risk tumor features associated with choroidal nevus transformation to melanoma. In the primary eye care setting where not all multimodal imaging may be available, we encourage color photography and OCT with referral for any features of basal diameter > 5 mm, presence of subretinal fluid, or thickness too large for capture by enhanced-depth imaging OCT. The authors have no proprietary or commercial interest in any materials discussed in this article.

An Analysis of Pediatric Ophthalmology Content on TikTok.

To assess pediatric ophthalmology-related information on TikTok (ByteDance). The 12 most commonly searched terms from the American Association for Pediatric Ophthalmology and Strabismus website were queried as TikTok hashtags. The top 20 videos for each hashtag were analyzed for views, likes, comments, saves, shares, author status and gender, content, and engagement level ratio (ELR). Subanalysis of the educational videos for quality, understandability and actionability, and medical accuracy using the modified DISCERN (mDISCERN), Patient Education Materials Assessment Tool (PEMAT), and modified Medical Information and Content Index (mMICI) was performed. Analysis of 222 videos revealed a cumulative 191,337,973 views. Patients/families created the most videos (60.4%), followed by optometrists (14.4%), other (laypeople/unknown) (9.0%), ophthalmologists (7.7%), non-ophthalmology physicians (4.5%), and nurses (4.1%). Content was predominantly patient experience (56.8%), followed by educational (25.2%), humor (11.7%), self-promotional (3.6%), procedures (0.9%), other (0.9%), advertisements (0.5%), and career (0.5%). Educational videos had a lower ELR than humorous (3.3 vs 8.2, P < .001) and patient experience (3.3 vs 5.3, P < .001) videos, but more saves than patient experience videos (74 vs 25, P = .009). The mDISCERN scores were greater for videos authored by ophthalmologists (3, P < .001) and optometrists (2.5, P < .001) compared to lay-people (1.5). Ophthalmologist PEMAT understandability scores were greater than non-ophthalmology providers' (95.5% vs 67.4%, P = .002). There was no difference in PEMAT actionability (P = .743) or mMICI scores among the author subgroups (P = .206). Pediatric ophthalmology content on Tik-Tok ranges in quality and understandability. Additional research is needed to help promote posts created by eyecare providers to ensure evidence-based medical content reaches pediatric patients and their families. [J Pediatr Ophthalmol Strabismus. 2024;61(2):90-97.].

Potential blindness from nutritional xerophthalmia in autistic patients

Vitamin A is vital to retinal rod function and epithelial cell differentiation. Although uncommon in the developed world, vitamin A deficiency (VAD) secondary to poor diets or gastrointestinal disease has been reported and can lead to xerophthalmia, which is characterized by night blindness and a spectrum of ocular surface changes. Patients with autism spectrum disorder have been shown to have restrictive diets secondary to sensory issues leading to rejection of foods except for those of certain color or texture. We present a case series of 6 pediatric patients with autism who developed varying degrees of xerophthalmia due to VAD, which resulted from restrictive eating. All patients presented with a history of eye irritation that was not relieved by antibiotic or allergy eye drops. Further questioning revealed they had restrictive diets consisting of only or mostly white and tan foods, and serum vitamin A testing confirmed severe VAD. Most stages of xerophthalmia were completely reversed with vitamin A supplementation, but in 2 patients more advanced xerophthalmia resulted in irreversible blindness and ocular damage. Both pediatricians and pediatric eye care providers must be vigilant for VAD as an etiology of eye irritation, photophobia, or new-onset visual impairment in autistic children. A review of the child's diet must be implemented as a standard part of routine history taken in this vulnerable population. Early identification and vitamin A supplementation can prevent irreversible ocular compromise and vision loss.

Stevens-Johnson syndrome in an 18-year-old Nigerian female: A case report

Purpose: This is a Stevens-Johnson syndrome (SJS) case with an atypical presentation. Stevens-Johnson syndrome is a hypersensitivity reaction distinguished by necrosis of skin tissue and mucosal linings including the genitals and eyes. It usually occurs as a reaction to certain medications. The condition is regarded as a medical emergency and management is tailored according to presenting symptoms with emphasis on airway and hemodynamic stability, lesion treatment, and prevention of opportunistic infection. While the condition is not hereditary, genetic codes passed on may increase the risk of similar immune-mediated hypersensitivity responses among progenies of affected individuals. Cyclosporine and other immunomodulatory therapeutics have shown promise in managing this condition.&#x0D; Case Report: This patient presented with severely reduced vision. The patient also had a recent history of bilateral ocular adnexal surgery and a family (father) history of kidney disease. An extensive case history, ocular workup, and microbial sensitivity testing were carried out to reach a diagnosis. The patient was initially placed doxycycline, Vitamin C, Moxifloxacin and Fluconazole. These were later adjusted when culture results returned. Unfortunately, due to the delay in presentation, the condition had progressed significantly, and management was palliative rather than restorative.&#x0D; Conclusion: A knowledge of SJS and quick intervention is key to minimizing morbidity and possible mortality from this condition. Management of this condition is multi-disciplinary and eye care providers should examine sufferers for ocular involvement so as to mitigate visual morbidity.

Prescribing patterns for paediatric hyperopia among paediatric eye care providers.

To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia. Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age-based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov-Smirnov cumulative distribution function test. Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age-normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5-2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years. Prescribing patterns for paediatric hyperopia vary significantly among eye care providers.

Prevalence of Visual Impairment and Availability of Eye Care Providers in Florida

To determine the association between prevalence of visual impairment and density of eye care providers in Florida counties. Cross-sectional study. SETTING: Population-based STUDY POPULATION: Ophthalmologist members of the American Academy of Ophthalmology, licensed optometrists, and respondents of the 2015-2020 American Community Survey administered by the United States Census Bureau. The number of ophthalmologists collected from the American Academy of Ophthalmology member directory and the number of optometrists collected from the Florida Department of Health License registry were compared to prevalence of visual impairment in each county as reported by American Community Survey 2020 5-year Estimates. Median age, mean income, race, and percent uninsured of each county were collected from American Community Survey 2020 5-year Estimates. Number of eye care providers and prevalence of visual impairment per Florida county. Eye care provider density and mean income of each county were negatively correlated with visual impairment prevalence. Counties with zero eye care providers had significantly higher prevalence of visual impairment per 100,000 residents than those with at least one eye care provider. While adjusting for mean income, for every increase in 1 eye care provider per 100,000 people, there was an expected decrease in visual impairment prevalence by 31.15±14.58 people per 100,000 residents. For every increase in mean county income by $1,000, there was an expected mean±SE decrease in prevalence of VI by 24.02±9.90 people per 100,000 people. Increased eye care provider density and mean county income is associated with lower prevalence of visual impairment in Florida counties. Further studies may elucidate the cause for this relationship and solutions to decrease visual impairment prevalence.

Level of Eye Care Among Eye Care Providers Themselves.

To assess the prevalence of eye disease and frequency of eye examinations among eye care providers themselves. In this cross-sectional study, an anonymous questionnaire was used to evaluate occurrence of eye disease and frequency of eye examinations among eye care providers including the clinicians (ophthalmologists, ophthalmology residents, and optometrists) as well as the support staff (ophthalmic technicians and eye clinic administrative staff). The survey response rate was 98 of 173 (56.6%) including 50 ophthalmic technicians, 27 ophthalmologists, 7 ophthalmology residents, 6 optometrists, and 8 eye clinic administrative staff members. The most common reported ocular condition was dry eye disease (36.7%). Myopia and hyperopia were present in 60 (61.2%) and 13 (13.3%), respectively. Myopia was significantly more prevalent among the clinicians (75.0%) than in the support staff (51.7%, P =0.02). The most recent eye examination was within the past year in 42 (42.9%), 1 to 2 years in 28 (28.6%), 3 to 5 years in 14 (14.3%), and over 5 years in 10 (10.2%). Four (4.1%) had never had an eye examination before. The number of eye examinations received was significantly higher in the support staff compared with the clinicians for the past one year (0.86±0.74 vs 0.43±0.59, respectively, P =0.003) and the past five years (2.81±2.08 vs 1.75±1.78, respectively, P =0.01). Dry eye disease and myopia are common among eye care providers. A significant portion of eye care providers do not have regular eye examinations for themselves.

Situation Analysis on the Applicability of a Communist Approach in the Delivery of Refractive Error Services in Kenya

Background: Refractive error is the leading cause of visual impairment globally. Different models are being applied to aid in the delivery of refractive error services. However, there is still a challenge when it comes to delivery of the services to the base of the pyramid population. As a result, there is course for an alarm to adopt a communist approach where each and every one will be able to access the services. Methodology: This was a prospective study in which respondents received the survey through online platforms. The survey was sent to 200 groups with each group having 150 participants. The Helsinki Declaration was adhered to. The response rate was 80% (24,000 out of 30,000). Results: Out of the 24,000 respondents, 60% were living in urban areas with 40% residing in rural areas. There was an association between the region of residence and access to refractive error services (t-test, p=0.04). The private sectors were 2.56 (95% CI 0.17–0.22) times likely to deliver refractive error services to the middle class living in urban areas compared to those residing in rural areas. The human resource remains a challenge as over 70% of the eye care providers are distributed within urban areas with less than 15% willing to work in rural areas.

The effect of filters and varying illumination on contrast sensitivity in eyes with moderate to severe visual impairment.

To investigate the effect of filters and illumination on contrast sensitivity in persons with cataract, pseudophakia, maculopathy and glaucoma to provide a guide for eye care providers in low vision rehabilitation. A within-subjects experimental design with a counter-balanced presentation technique was employed in this study. The contrast sensitivity of eyes with cataract, pseudophakia, maculopathy and glaucoma was measured with filters (no filter, yellow, pink and orange) combined with increasing illumination levels (100lx, 300lx, 700lx and 1000lx) using the SpotChecks™ contrast sensitivity chart. The data were analyzed using descriptive statistics and two-way repeated measures ANOVA. The yellow filter at 100lx significantly improved contrast sensitivity in the maculopathy group. There were no significant improvements with either intervention in the rest of the groups. There was, however, a significant interaction between filters and illumination in the cataract group. There were small improvements in contrast sensitivity at low illumination levels with the yellow filter in the maculopathy group, and this could be considered in clinical practice and low vision rehabilitation. Overall, filters at most illumination levels did not benefit most groups.