Eye Care Providers Research Articles

Race, poverty, and the lack of follow-up for Arkansas students that fail vision screenings: a cross-sectional study over 7 years

To analyze rates of follow-up eye care for students that failed school vision screenings over a 7-year period in 238 Arkansas school districts. In this cross-sectional study, vision screening, demographic, socioeconomic, academic, and eye care provider data were collected. The main outcomes were referral rates, rates of follow-up eye care for students with failed vision screenings, and estimated associations between the rate of follow-up and school district and county-level characteristics, such as race, poverty, insurance coverage, academic achievement, and the number of eye care providers. A total of 1,744,805 vision screenings over 7 academic years (2013-2020) were included. The average screening rate was 35.4% across the study years. The screening failure rate ranged from 8.0% to 9.4%. Two-thirds of districts had a follow-up rate between 20% and 50%. 91% had follow-up rates of <60%. School districts with higher concentrations of White students (P < 0.001), higher graduation rates (P = 0.024), higher percentages of students on government-assisted insurance (P = 0.035), and higher standardized scores (P < 0.001) had higher rates of follow-up. There were no statistically significant relationships between the rate of follow-up eye care and the number of school nurses per school district or the number of ophthalmologists or optometrists per county. Arkansas children in our study cohort that failed vision screenings had inadequate follow-up eye care. Follow-up rates were associated with several key indicators of socioeconomic status.

Evaluating the Efficacy of Teleophthalmology in Delivering Ophthalmic Care to Underserved Populations: A Literature Review.

Technological advancement has brought commendable changes in medicine, advancing diagnosis, treatment, and interventions. Telemedicine has been adopted by various subspecialties including ophthalmology. Over the years, teleophthalmology has been implemented in various countries, and continuous progress is being made in this area. In underserved populations, due to socioeconomic factors, there is little or no access to healthcare facilities, and people are at higher risk of eye diseases and vision impairment. Transportation is the major hurdle for these people in obtaining access to eye care in the main hospitals. There is a dire need for accessible eye care for such populations, and teleophthalmology is the ray of hope for providing eye care facilities to underserved people. Numerous studies have reported the advantages of teleophthalmology for rural populations such as being cost-effective, timesaving, reliable, efficient, and satisfactory for patients. Although it is being practiced in urban populations, for rural populations, its benefits amplify. However, there are certain obstacles as well, such as the cost of equipment, lack of steady electricity and internet supply in rural areas, and the attitude of people in certain regions toward acceptance of teleophthalmology. In this review, we have discussed in detail eye health in rural populations, teleophthalmology, and its effectiveness in rural populations of different countries.

Patients with Low Vision Struggle with Placing Eye Drops and Benefit from an Eye Drop Aid

To evaluate eye drop self-administration in a low vision patient population and test if a nose-pivoted drop delivery device (NPDD, GentleDropTM, Portland, OR) can improve eye drop delivery in these patients. Repeated-measures case series. Thirty subjects (58 eyes) with low vision, defined as best-corrected visual acuity worse than 20/60 or visual field worse than 20 degrees in the better seeing eye. We video-recorded subjects while self-administering eye drops using their own traditional delivery at baseline, after a standardized teaching, and with a NPDD. Two masked graders independently reviewed each drop delivery. Primary success was defined as the drop reaching the eye without the bottle touching the eye or eyelids. Subjects rated ease-of-use (1-10 scale, 10=easiest) after each drop delivery and completed a satisfaction survey, which included asking whether subjects could place drops independently (1-5 scale, 5=most independent). Logistic-transformed generalized estimating equation (GEE) regression to compare technique satisfaction, ease-of-use, independence, no contact, and success. Primary success was observed in 30 of 58 eyes (52%) at baseline and increased to 44 eyes (76%) with a NPDD (p=0.013). Bottle tip contact occured in 23 of 58 eyes (40%) at baseline and 8 eyes (14%) with a NPDD (p=0.004). Mean ease-of-use scores were 6.7 ± 3.1 at baseline and 8.3 ± 1.8 (p<0.001) with a NPDD. Likewise, the NPDD improved success, bottle tip contact, and ease-of-use compared to post-teaching traditional delivery (p<0.01). Twenty-two of 30 subjects (73%) preferred the NPDD to traditional delivery. Twenty-nine (97%) thought the NPDD was comfortable to use, and all would recommend the device. A subgroup analysis was performed on 16 subjects that self-reported difficulty instilling drops at baseline. The NPDD showed similar results, and it increased confidence in placing drops independently (4.6 ± 0.9) compared to baseline (2.7 ± 1.6, p<0.001). Fifteen (94%) subjects in this subgroup preferred the NPDD. Low vision subjects struggled to self-administer eye drops. A NPDD can improve bottle tip contact, ease-of-use, satisfaction, and independence. Eye care providers could consider screening low vision patients about difficulty with eye drop self-administration and recommending eye drop aids.

People with dry age‐related macular degeneration; views on certification of vision impairment in a primary care setting: An explorative qualitative study

Evidence supports the clinical decision-making ability of primary care optometrists with additional qualifications in the identification of eligibility criteria for the certification of vision impairment (CVI). Welsh Government policy is driving pathway change to enable these optometrists to perform CVI. This qualitative study explores the views of people with VI due to dry age-related macular degeneration (AMD) on this pathway change. Nine people with VI due to dry AMD, attending Macular Society support groups, participated. Individual semi-structured interviews were conducted and analysed concurrently using thematic analysis. Five major themes were identified: (1) living with dry AMD, (2) experience of eye care provision, (3) knowledge of CVI, (4) provision of information and (5) CVI in primary care. Participants consistently highlighted the need for the provision of accessible information regarding the certification pathway, dry AMD and the optometrist's role in the provision of eye health care. Information needs to be available prior to the diagnosis of an eye disease, rather than only from the point of diagnosis or where the vision reaches the level required for certification. The findings support the provision of CVI within primary eye care while highlighting areas of importance in pathway development. These include the provision of accessible information prior to, at the point of and following the diagnosis of an eye condition. Information provided needs to extend to the awareness of the role of the optometrist in the provision of eye care, and public health awareness of modifiable risk factors, which will influence the possibility of disease development in later life. The findings provide information that will be useful to those responsible for the provision of CVI within primary care.

Amsler Grid Versus 10-2 Test in Primary Open Angle Glaucoma.

Glaucoma is the leading cause of global irreversible blindness. The goal of management in glaucoma lies in its early detection and treatment to prevent further optic neuropathy. Available equipment for early glaucoma detection is not cost-effective or readily available in resource-scarce settings such as Nigeria. Thus, there is a need for a simple cost-effective tool to detect glaucomatous central visual field (CVF) defects in all the stages of glaucoma within the community in resource scarce-settings. The aim of this article is to determine the validity of the Amsler grid in detecting central glaucomatous visual field defects in primary open angle glaucoma (POAG). This was a cross-sectional study of follow-up glaucoma patients at a secondary eye care hospital in Nigeria. All patients had detailed ophthalmic examination in addition to 24-2 and 10-2 CVF tests and Amsler grid test. POAG was classified using the Hodapp-Parrish-Anderson criteria into mild, moderate, and severe on 24-2 CVF. The diagnostic validity of the Amsler grid was calculated using the 10-2 CVF as a reference standard. Regression analyses were performed between the Amsler grid scotoma area and 10-2 CVF parameters [mean deviation (MD), scotoma extent (SE), and scotoma mean depth (SMD)]. A total of 150 eyes of 150 patients were enrolled. The sensitivity, specificity, and positive predictive value and negative predictive value of the Amsler grid compared with the 10-2 CVF was 49.5%, 95.9%, 96.2%, and 47.9%, respectively, with an area under curve of 0.7. Sensitivity increased with increasing severity (P < 0.001) from 20.0%, 31.0%, and 76.6% in mild, moderate, and severe POAG, respectively. The Amsler grid scotoma area had the strongest relationship with the 10-2 MD, followed by 10-2 SE and 10-2 SMD with a quadratic R2 of 0.579, 0.370, and 0.307, respectively. The Amsler grid has a low sensitivity in mild-to-moderate POAG. However, it may serve as an adjunctive tool in resource-scarce settings for detection of severe POAG in the community by primary eye care providers.

Practice Patterns in the Initial Management of Herpes Zoster Ophthalmicus in the United States.

The aims of this study were to examine the trends in the initial management of herpes zoster ophthalmicus (HZO) in the United States from 2010 to 2018 and compare them with the treatment preferences of corneal specialists. A retrospective, observational deidentified cohort study was conducted on individuals enrolled in the OptumLabs Data Warehouse who had a new diagnosis of HZO from 1/1/2010 to 12/31/2018. An online survey ascertaining HZO management perspectives was distributed to The Cornea Society listserv. The main outcome assessed was proportion of cases with systemic antiviral prescriptions, eye care provider involvement, and follow-up visits after the initial HZO diagnosis. Approximately 50% of patients received systemic antivirals the day of initial HZO diagnosis or within 7 days (45.6% and 53.7%, respectively). Most initial diagnoses were made by ophthalmologists (45.0%), followed by optometrists (19.2%). Referral rate to ophthalmology within a year of initial diagnosis was 38.6%. 48.7% cases had at least 1 follow-up visit with any type of provider within 30 days. Our survey of corneal specialists found 97% would prescribe systemic antivirals to those with ocular involvement, but 66% would prescribe antivirals to those without ocular or eyelid involvement. Seventy percent supported all patients having follow-up with an eye care provider within a month. HZO antiviral therapies seem to be underprescribed in the United States, referral rates to ophthalmology are low, and follow-up is suboptimal, which are not aligned with recommendations from corneal specialists. More research is needed to establish standardized guidelines for treatment, referral, and follow-up with ophthalmology for HZO.

Clinical validation of a novel smartphone application for measuring best corrected visual acuity

PurposePersonal mobile devices such as smartphones are proving their usefulness in ever more applications in tele-eyecare. An inconvenience and potential source of error in these past approaches stemmed from the requirement for the subjects to situate their devices at a distance. The present study aims to clinically validate best corrected visual acuity (BCVA) measures carried out by a novel smartphone application “vision.app” (VisionApp Solutions S.L.) using comparative statistics against clinical measurements. Materials and methodsBCVA was measured in both eyes of 40 subjects using vision.app which displayed a black Landolt-C optotype with crowding on a white background, and utilized a 4 forced-choice procedure for the subjects to find (by means of swiping in either of four directions) the smallest optotype size they could resolve. Results were compared to BCVA measurements taken using a standard Snellen chart placed at 20 feet (6 m). ResultsThe t-test revealed no significant differences between the app- and clinically-measured VA (p = 0.478 (OD) and 0.608 (OS)), with a mean difference between clinical and app measurements of less than one line of the eye chart (-0.009 logMAR (OD) and -0.005 logMAR (OS)). A limit of agreement for a 95% confidence interval of ± 0.08 logMAR for OD and OS was found. ConclusionsThe results show the potential use of a smartphone to measure BCVA at a handheld distance. The newly validated study results can hold major future advancements in tele-eyecare and provide eye care professionals with a reliable and accessible method to measure BCVA.

Incidence and distribution of ocular disorders in the first year of life

To describe the incidence and distribution of eye diseases affecting children in the first year of life in Olmsted County, Minnesota. We conducted a population-based, retrospective medical record review of infants (≤1 year of age) residing in Olmsted County diagnosed with an ocular disorder from January 1, 2005, through December 31,2014. A total of 4,223 infants were diagnosed with an ocular disorder, yielding an incidence of 20,242/100,000 births per year, or 1 in 4.9 live births (95% CI, 19,632-20,853). The median age at diagnosis was 3 months, and 2,179 (51.5%) were female. The most common diagnoses included conjunctivitis, in 2,175 (51.5%), nasolacrimal duct obstruction, in 1,432 (33.6%), and pseudostrabismus, in 173 (4.1%). Visual acuity was decreased in one or both eyes in 23 (0.5%) infants because of strabismus in 10 (43.5%) and cerebral visual impairment in 3 (13.0%). A majority of the infants (3,674 [86.9%]) were diagnosed and managed by a primary care provider, and 549 (13.0%) were evaluated and/or managed by an eye care provider. Although ocular disorders occurred in 1 in 5 infants in this cohort, most conditions were evaluated and managed by primary care providers. Understanding the incidence and distribution of ocular diseases among infants is useful for planning clinical resources.

Disparities in eye clinic patient encounters among patients requiring language interpreter services

BackgroundCommunication barriers are a major cause of health disparities for patients with limited English proficiency (LEP). Medical interpreters play an important role in bridging this gap, however the impact of interpreters on outpatient eye center visits has not been studied. We aimed to evaluate the differences in length of eyecare visits between LEP patients self-identifying as requiring a medical interpreter and English speakers at a tertiary, safety-net hospital in the United States.MethodsA retrospective review of patient encounter metrics collected by our electronic medical record was conducted for all visits between January 1, 2016 and March 13, 2020. Patient demographics, primary language spoken, self-identified need for interpreter and encounter characteristics including new patient status, patient time waiting for providers and time in room were collected. We compared visit times by patient’s self-identification of need for an interpreter, with our main outcomes being time spent with ophthalmic technician, time spent with eyecare provider, and time waiting for eyecare provider. Interpreter services at our hospital are typically remote (via phone or video).ResultsA total of 87,157 patient encounters were analyzed, of which 26,443 (30.3%) involved LEP patients identifying as requiring an interpreter. After adjusting for patient age at visit, new patient status, physician status (attending or resident), and repeated patient visits, there was no difference in the length of time spent with technician or physician, or time spent waiting for physician, between English speakers and patients identifying as needing an interpreter. Patients who self-identified as requiring an interpreter were more likely to have an after-visit summary printed for them, and were also more likely to keep their appointment once it was made when compared to English speakers.ConclusionsEncounters with LEP patients who identify as requiring an interpreter were expected to be longer than those who did not indicate need for an interpreter, however we found that there was no difference in the length of time spent with technician or physician. This suggests providers may adjust their communication strategy during encounters with LEP patients identifying as needing an interpreter. Eyecare providers must be aware of this to prevent negative impacts on patient care. Equally important, healthcare systems should consider ways to prevent unreimbursed extra time from being a financial disincentive for seeing patients who request interpreter services.

Pediatric and School-Age Vision Screening in the United States: Rationale, Components, and Future Directions

Pediatric vision screening detects children at risk for visual conditions with the goal of connecting those in need with an eye care provider for evaluation and treatment. The primary aim for vision screening in younger children is the detection of those at risk for amblyopia, which can result in irreversible vision loss if left untreated. In older children, screening goals broaden to include the detection of risk for uncorrected refractive error. In the United States, professional organization guidelines and state-mandated requirements for vision screening vary widely across both the timing and components of screening. In this article, we describe the goals and components of pediatric vision screenings, current challenges, novel approaches to providing follow-up services through school-based vision programs, and future directions.

Mumbai metropolitan region eye care facility survey: Mumbai Eye Disease Study (MEDiS) report #1.

To examine the eye care practice in the Mumbai Metropolitan Region (MMR). This study consisted of primary and secondary research conducted in five zones of MMR. The primary research included interviews with the patients, eye care providers, and key opinion leaders. The secondary research included analyzing data from the professional ophthalmology societies, public health domain, and health insurance providers. We divided people into three economic classes by annual income - low (<INR 0.3 m), middle (INR 0.31-1.8 m), and high (>1.8 m). We analyzed the collected data to estimate the eye care demand-supply, quality of eye care, health-seeking behavior, gap in eye care delivery, and eye care expenditure. We examined 473 key eye care facilities and interviewed 513 people. The ophthalmologist density in MMR was 80/million, and it was the highest in North MMR. Most ophthalmologists visited several facilities. Cataract surgery and glaucoma care coverage were better than other specialties; it was poor for oncology and oculoplastic services. Annual eye examination practice was poor in the low- and middle-income groups than in the high-income group (48%-50% vs. 85%). Most people preferred visiting eye care facilities within 5 km of their residence. Out-of-pocket spending was between 60% and 83%. Lower-income group people preferred public facilities. MMR eye care needs further improvement in affordable and accessible eye care, health literacy, public health surveillance, research into the application of newer technologies to provide less-expensive home care for the elderly and minimize their hospital visits, and collection and analysis of big data to address city-specific eye health issues.

Evaluation of a combined school-based vision screening and mobile clinic program

Effective vision screening programs for children require follow-up with eye care providers, but studies demonstrate poor follow-up rates after failed screenings. Programs have attempted to address this issue by providing free examinations and glasses after failed screenings. This study presents data from a mobile clinic program that provides instrument-based vision screening, eye examinations, and free glasses directly to children at school. Between 2018 and 2021, a nonprofit organization provided in-school instrument-based screening and noncycloplegic examinations and refractions in elementary, middle, and high schools. Deidentified screening and clinic data were reviewed retrospectively. Information about each school regarding total student enrollment, enrollment based on race, and number of economically disadvantaged students was obtained from the Virginia Department of Education. In the 2019-2020 school year, 14,006 students from 58 schools were screened, and 4,238 (30.3%) were referred. The percentage of economically disadvantaged students was positively correlated to referral rate (R2 = 0.406). Between 2019 and 2020, the mobile clinic examined 3,095 students from the same 58 schools. Of these, 72.9% were prescribed glasses, and 16.3% were referred for a more comprehensive eye examination and treatment. Students were also diagnosed with cataracts, nystagmus, amblyopia, and strabismus. A combined screening program and mobile clinic traveling directly to schools can provide a pipeline for delivering eye care to vulnerable populations.

Cataract Formation Following Pars Plana Vitrectomy in the Pediatric Population.

To analyze post-vitrectomy cataract formation in the pediatric population to elucidate the number of phakic children requiring cataract surgery following vitreous surgery and the perioperative factors affecting cataract development in these patients. Eyes of pediatric patients that underwent phakic pars plana vitrectomy (PPV) with no prior cataract in a 10-year period were included. Analyses evaluated relationships between patient age and time to cataract surgery, as well as contributing factors for cataract formation. Final visual outcomes were also examined. Outcomes were collected for patient age at first vitrectomy, indication for vitrectomy, use of tamponade agents, history of ocular trauma, cataract status, and time to cataract surgery from first vitrectomy. Of 44 eyes analyzed, 27 (61%) were noted to have some degree of cataract formation. Of these, 15 (56%; 34% of total eyes) underwent cataract surgery. Use of octafluoropropane (P = .04) or silicone oil (P = .03) positively correlated with the need for cataract surgery in the total study group. Patients requiring cataract surgery had worse endpoint visual acuities than those who did not undergo surgery (P = .02), although this difference becomes less significant in follow-up over 2 years (P = .30). Patients who had cataracts but did not need cataract surgery showed an improvement in visual acuity (P = .04), but this was not demonstrated in patients who did need cataract surgery (P = .90). Pediatric eye care providers should be aware of the significant risk of cataract formation following a phakic PPV. [J Pediatr Ophthalmol Strabismus. 2023;60(6):421-426.].

Associations between Socioeconomic Factors and Visit Adherence among Patients with Glaucoma in the All of Us Research Program

To identify socioeconomic factors associated with visit adherence among patients with glaucoma in a nationwide cohort. Cross-sectional study. All subjects were participants in the National Institutes of Health All of Us Research Program. This study cohort consists of participants who were diagnosed with glaucoma and who answered the question on the Health Care Access and Utilization Survey regarding whether they have seen an eye care provider in the last 12 months. Descriptive analyses were conducted based on participant age, gender, race/ethnicity, insurance status, level of education, and income bracket. Multivariable logistic regression adjusting for these factors was used to generate odds ratios (ORs) for the association between socioeconomic factors and visit adherence. Visit adherence, defined as reporting seeing an eye care provider in the last 12 months. Among 4517 patients with glaucoma, 730 (16.3%) indicated that they had not seen or spoken to an eye doctor in the last 12 months. In multivariable models, those with some college education (OR: 1.91; 95% confidence interval [CI]: 1.19-3.04) and those with a college degree or advanced degree (OR: 2.25; 95% CI: 1.39-3.60) and those with the highest annual income of ≥ $200 000 (OR: 1.64; 95% CI: 1.10-2.45) were more likely to have seen an eye doctor in the past year compared with those in the lowest education and income categories, respectively. Lower income and education levels were significantly associated with lower odds of seeing an eye doctor in the past year among all patients with glaucoma in All of Us. This highlights an important health disparity and may inform subsequent interventions to promote improved adherence to clinical guidelines regarding eye care for glaucoma monitoring and management. Proprietary or commercial disclosure may be found after the references.

Topical Anesthetics for Analgesia in Acute Corneal Abrasion: Eye Care Providers Survey.

To evaluate the current attitudes of ophthalmologists and optometrists regarding topical anesthetic (TA) use in the emergency department (ED) for analgesia in corneal abrasions. A survey was distributed through email to ophthalmologists and optometrists, and their responses were deidentified. Three scenarios were presented involving the addition of tetracaine in addition to usual care in the setting of uncomplicated corneal abrasion. A 250-character space for comments and demographic questionnaire followed. A chi-square test, Fisher exact test, or sign test, at a significance level of 0.05, was used. Of the 978 individuals surveyed, 486 responded (MD/DOs: 47.1% and ODs: 52.9%). Topical anesthetic favorability significantly decreased with shorter practice length when the patient was only examined by an ED provider. Topical anesthetic favorability was significantly impacted by respondents' degree type. When respondents were posed with using TAs if the respondents were the patient, the respondents were 22.6% more likely to use TA when compared with their answers in the scenario where the ED provider examined the patient and 20.0% more likely when compared with the scenario where a MD/OD examined the patient. Most did not support tetracaine use. Although treating pain is associated with improved quality of life, most respondents did not support TA use in the ED. Practice length and degree type significantly impacted responses. Respondents were more inclined to use TAs when the respondents were the patient. Results suggest that eye care providers need additional research data supporting safety before routine use in the ED, given the potential for adverse events with TAs.

Barriers and facilitators in the referral pathways to low vision services from the perspective of patients and professionals: a qualitative study

BackgroundUnderutilization of and lack of access to low vision services (LVS) has been reported internationally. The purpose of this study was to identify barriers and facilitators in LVS referral procedures and service delivery from both the perspective of people with visual impairment and professionals from different eye care providers in the Netherlands.MethodsA qualitative study in the Netherlands was conducted. Barriers and facilitators were explored through semi structured interviews with older adults with macular degeneration, diabetic retinopathy and/or glaucoma (n = 14), and healthcare professionals including ophthalmologists and LVS professionals (n = 16). Framework analysis was used for analyzing the interviews with Atlas.ti software.ResultsAccording to both patients and professionals, facilitators in LVS access and utilization are having motivation, self-advocacy, high participation needs and social support, as well as being negatively impacted by the impairment. Both samples found having good communication skills and informing patients about LVS as a healthcare provider to facilitate access. A long patient-provider relationship and the Dutch healthcare system were also mentioned as facilitators. Professionals additionally found long disease duration and the presence of low vision optometric services in the ophthalmic practice to promote access.Barriers that were reported by patients and professionals are lack of motivation, self-advocacy and acceptance of the impairment in patients. In addition, having low participation needs as a patient, lack of information provision by providers and time constraints in the ophthalmic practice were mentioned as barriers. Professionals also reported lack of social support, short disease duration of patients, a short patient-provider relationship and lack of coordination of care in the ophthalmic practice to hinder access.ConclusionsFindings suggest that providers’ lack of information provision about LVS, especially to patients who are less assertive, hamper referral to LVS. Providers should have attention for patients’ LVS needs and actively inform them and their social network about LVS to facilitate access. Educating and training providers about how and when to address LVS may help to reduce barriers in the referral pathways. In addition, referral procedures may benefit from tools that make providers more aware of LVS.

Transformation of Eye Care Through Innovations.

Transformation of Eye Care Through Innovations.

Integration of Refractive Services Provided by Optometrists into the Portuguese National Health Service

Introduction: Refractive error is a public health concern and even with relatively simple and cost-effective interventions it remains usually outside national health services (NHSs) not ensuring universal health coverage. This study aimed to generate evidence about the availability and accessibility of refractive services in Portugal and to present a plan for more efficient services. Methods: A situation analysis of the Portuguese existing refractive services within the NHS was conducted based on three health systems building blocks: service delivery access, service coverage, and workforce. A strengths, weaknesses, opportunities, and threats analysis was performed based on existent evidence to identify internal and external factors that can facilitate or hinder the integration of refractive services within the NHS. The number of eye care personnel to be integrated in the NHS was calculated considering the minimum ratios recommended by national and international technical reports. Results: Portugal has no specific services to address refractive errors within the NHS. Treatment of refractive error occurs at the level of eye care general services. There are 39 NHS eye care services, all hospital-centred and divided into three large groups, according to technical differentiation, the technology required, and workforce capacity. The workforce available is composed of ophthalmologists and orthoptists, together with nurses and other general paramedical assistants. 3 Portuguese municipalities have more than 1 NHS eye care service, 35 have 1 NHS eye care service, and 240 municipalities (in the mainland) have none. In 2021, 52% of the hospitals providing eye care services did not meet the recommended response times. Centralization of eye care services in urban areas, undifferentiated referral systems, and a shortage in the workforce per inhabitant was observed. Conclusions: Portuguese NHS has all the requirements to reorientate refractive care from the current hospital-based model to primary care. The country also has a trained and qualified workforce to address this condition. Evidence demonstrates that the provision of refractive services at primary care is efficient and effective and translates into an opportunity to identify other visual conditions.

Technology and Innovation in Global Ophthalmology: The Past, the Potential, and a Path Forward.

Technology and Innovation in Global Ophthalmology: The Past, the Potential, and a Path Forward.

THE MOMENTARY EFFECT OF XYLOPIA AETHIOPICA ON INTRAOCULAR PRESSURE

Xylopia aethiopica is an important item of local trade throughout Africa as a spice, flavouring for food and for medicine. The aim of this study was to determine the effect of aqueous extract of its fruit on intraocular pressure (IOP) of normotensive subjects. A total of eighty (n=80) ocular normotensives between 18 and 50 years, with mean age of 27.28±7.84years and mean body weight of 64.45±12.70kg consisting of forty (40) (50%) males and forty (40) (50%) females, were recruited for this study. Their baseline intraocular pressure was measured and intraocular pressure was taken for 30, 60 and 90 minutes after ingestion of either distilled water or aqueous extract of Xylopia aethiopica fruit. The mean baseline intraocular pressure was 13.52±1.70mmHg; 30minutes after ingestion of the aqueous extract of Xylopia aethiopica, there was a significant increase in mean intraocular pressure to 15.55±2.00mmHg (p&lt; 0.05); after 60minutes the mean IOP decreased to 14.43±1.62mmHg and then returned close to mean baseline IOP of 13.45±1.80mmHg.There was no significant change in mean IOP (p&gt; 0.05) when males were compared withfemales. Xylopia aethiopica causes a transient fluctuation in IOP which may affect thefindings and analyses of IOP. Eye care providers should be cautious of raised IOP inducedby spices like X. aethiopica; and ask patients about their meals or medications before IOPmeasurements are taken.