Eye Clinic Research Articles

Analysis of Treatment Efficacy of Intense Pulsed Light (M22) for Meibomian Gland Dysfunction with Demodex Mites.

To investigate the effectiveness of intense pulsed light (M22) in treating patients with meibomian gland dysfunction (MGD) caused by demodex mites. A total of 100 patients (100 eyes) diagnosed with demodex mites through microscopic examination at Shanxi Bethune Eye Clinic between June 2021 and May 2023 were selected using convenience sampling. The patients were randomly divided into two groups: an experimental group (n=50) and a control group (n=50). The control group received comprehensive treatment consisting of artificial tears, warm compress, anti-inflammatory eye ointment, hypochlorous acid cleansing, okra cotton pad, and meibomian gland massage. In addition to the comprehensive treatment, the experimental group received intense pulsed light (M22) therapy. After 8 weeks of treatment, the mite clearance rate and cure rate of dry eye were measured for both groups. The recurrence rate of dry eye was also observed 4 weeks after discontinuing M22 treatment. The experimental group achieved a mite clearance rate of 88.0%, while the control group had a rate of 58.0%, with a statistically significant difference (χ2 = 5.43, P = 0.017). Regarding the cure rate of dry eye, the experimental group showed a rate of 92.0%, while the control group had a rate of 82.0%, with a statistically significant difference (χ2 = 3.61, P = 0.021). In terms of the recurrence rate of dry eye, the experimental group exhibited a rate of 13.04%, while the control group had a rate of 26.83%, with a statistically significant difference (χ2 = 4.18, P = 0.016). Intense pulsed light (M22) demonstrated superior efficacy in eradicating demodex mites, treating dry eye, and maintaining the treatment's effectiveness compared to comprehensive treatment with medication in patients suffering from meibomian gland dysfunction with demodex mites.

AI-Based Decision-Support System for Diagnosing Acanthamoeba Keratitis Using In Vivo Confocal Microscopy Images.

In vivo confocal microscopy (IVCM) of the cornea is a valuable tool for clinical assessment of the cornea but does not provide stand-alone diagnostic support. The aim of this work was to develop an artificial intelligence (AI)-based decision-support system (DSS) for automated diagnosis of Acanthamoeba keratitis (AK) using IVCM images. The automated workflow for the AI-based DSS was defined and implemented using deep learning models, image processing techniques, rule-based decisions, and valuable input from domain experts. The models were evaluated with 5-fold-cross validation on a dataset of 85 patients (47,734 IVCM images from healthy, AK, and other disease cases) collected at a single eye clinic in Sweden. The developed DSS was validated on an additional 26 patients (21,236 images). Overall, the DSS uses as input raw unprocessed IVCM image data, successfully separates artefacts from true images (93% accuracy), then classifies the remaining images by their corneal layer (90% accuracy). The DSS subsequently predicts if the cornea is healthy or diseased (95% model accuracy). In disease cases, the DSS detects images with AK signs with 84% accuracy, and further localizes the regions of diagnostic value with 76.5% accuracy. The proposed AI-based DSS can automatically and accurately preprocess IVCM images (separating artefacts and sorting images into corneal layers) which decreases screening time. The accuracy of AK detection using raw IVCM images must be further explored and improved. The proposed automated DSS for experienced specialists assists in diagnosing AK using IVCM images.

Accuracy of Toric Intraocular Lens Calculations Using Estimated Versus Measured Posterior Corneal Astigmatism

To compare the prediction accuracy of toric intraocular lens calculations using estimated vs measured posterior corneal astigmatism (PCA). Retrospective case series. A total of 110 eyes of 110 patients with uncomplicated toric intraocular lens implantation were included in this study. Predicted postoperative refractive astigmatism was calculated with the Barrett Toric Calculator using the estimated PCA (E-PCA), the measured IOLMaster 700 PCA (I-PCA), and the measured Pentacam PCA (P-PCA). Refractive astigmatism prediction errors (RA-PEs), including their trimmed (tr-) centroid (mean vector), spread (precision), tr-mean absolute RA-PE (accuracy), and percentage within a certain threshold, were determined using vector analysis and compared between groups. University Eye Clinic, Maastricht University Medical Center+, the Netherlands. The tr-centroid RA-PEs of the E-PCA (0.02 diopter [D] at 82.2°), the I-PCA (0.08 D at 35.5°), and the P-PCA (0.09 D at 69.1°) were significantly different from each other (P < .01), but not significantly different from zero (P = .75, P = .05, and P = .05, respectively). The E-PCA had the best precision (tr-mean 0.40 D), which was not significantly lower than the I-PCA (0.42 D, P = .53) and P-PCA (0.43 D, P = .06). The E-PCA also had the best accuracy (0.40 D), which was not significantly different from the I-PCA (0.42 D, P = .26) and significantly better than the P-PCA (0.44 D, P < .01). The precision and accuracy of the I-PCA did not significantly differ from those of the P-PCA. There were no statistically significant differences in the percentage of eyes within a certain absolute RA-PE threshold. The Barrett Toric Calculator using the E-PCA, I-PCA, or P-PCA showed a comparable prediction of postoperative refractive astigmatism in standard clinical practice.

Sociodemographic characteristics of community eye screening participants: protocol for cross-sectional equity analyses in Botswana, India, Kenya, and Nepal

Background Attendance rates for eye clinics are low across low- and middle-income countries (LMICs) and exhibit marked sociodemographic inequalities. We aimed to quantify the association between a range of sociodemographic domains and attendance rates from vision screening in programmes launching in Botswana, India, Kenya and Nepal. Methods We performed a literature review of international guidance on sociodemographic data collection. Once we had identified 13 core candidate domains (age, gender, place of residence, language, ethnicity/tribe/caste, religion, marital status, parent/guardian status, place of birth, education, occupation, income, wealth) we held workshops with researchers, academics, programme implementers, and programme designers in each country to tailor the domains and response options to the national context, basing our survey development on the USAID Demographic and Health Survey model questionnaire and the RAAB7 eye health survey methodology. The draft surveys were reviewed by health economists and piloted with laypeople before being finalised, translated, and back-translated for use in Botswana, Kenya, India, and Nepal. These surveys will be used to assess the distribution of eye disease among different sociodemographic groups, and to track attendance rates between groups in four major eye screening programmes. We gather data from 3,850 people in each country and use logistic regression to identify the groups that experience the worst access to community-based eye care services in each setting. We will use a secure, password protected android-based app to gather sociodemographic information. These data will be stored using state-of-the art security measures, complying with each country’s data management legislation and UK law. Discussion This low-risk, embedded, pragmatic, observational data collection will enable eye screening programme managers to accurately identify which sociodemographic groups are facing the highest systematic barriers to accessing care at any point in time. This information will be used to inform the development of service improvements to improve equity.

Georg Joseph Beer (1763–1821): founder of the First University Eye Clinic

Georg Joseph Beer (1763–1821): founder of the First University Eye Clinic

Demographic and socioeconomic disparities in the hybrid ophthalmology telemedicine model.

As telemedicine use expands, it is important to evaluate demographic and socioeconomic disparities among patients receiving ophthalmic care through new hybrid telemedicine models. To evaluate whether there are demographic and socioeconomic disparities in the delivery of the hybrid telemedicine model. Retrospective, cross-sectional, case-control analysis of patient encounters from April to December 2020. A single, academic, hospital-based eye clinic in Boston, Massachusetts. Electronic medical records of all patient encounters from April to December 2020 were reviewed and categorized into hybrid, virtual-only, and standard in-person visits. Patient-level data for all visits were extracted including age, sex, race/ethnicity, primary language, Area Deprivation Index (ADI), insurance type, and marital status. Visit-level data for all hybrid visits were also extracted from the medical record including the visit dates and patient adherence. Demographics for the cohort of patients with at least one no-show visit were compared with demographics for the cohort of patients who only had completed visits. The primary study outcomes were the differences in demographic characteristics between the hybrid visit show and no-show groups. The secondary outcomes included demographic characteristics of patients who did not complete their hybrid visit versus a time-matched cohort of patients who did not complete their standard in-person visit. Continuous variables for patient characteristics were compared with independent samples t-tests and categorical variables were compared using Pearson chi-square tests. Multivariate logistic regression was used to examine the differences between the cohorts. Variables with missing values other than suppressed ADI values were imputed using multiple imputations by chained equations. Of a total of 1025 patients who were scheduled for a hybrid visit, 145 (14.1%) patients failed to complete their visit. Primary language and insurance were found to be statistically different between patients who completed and did not complete their hybrid visits. More English speakers and fewer Haitian Creole speakers completed their hybrid visits (p = 0.007) while more patients with private insurance and fewer patients with Medicaid completed their hybrid telemedicine visits (p = 0.026). No associations were found between hybrid telemedicine visit adherence and age, sex, race/ethnicity, marital status, or ADI. When the 145 patients who failed to complete their hybrid visits were compared to a time-matched cohort of patients who failed to complete their standard in-person visit, we found that patients who missed hybrid visits were similar to those who missed standard in-person visits except for patients insured by Medicare. These patients were more likely to miss a hybrid visit than a standard in-person visit (Odds Ratio 2.199, 95% confidence interval 1.136-4.259, p = 0.019). No associations were found between patient nonadherence with hybrid telemedicine versus with standard in-person visits based on age, sex, primary language, race/ethnicity, marital status, or ADI. The hybrid telemedicine model was associated with insurance and language-based disparities. Patients with non-English primary language and Medicaid recipients were more likely to miss a hybrid visit than their counterparts. Our findings support developing deliberate interventions to ensure hybrid telemedicine care is delivered equitably to all patients.

Accuracy and Feasibility of Three-Dimensional Ultrasound Testing in Eye Clinic and Emergency Department Patients with Vision Complaints

BackgroundOcular emergencies comprise 2–3% of emergency department (ED) visits, with retinal detachment requiring emergency surgery. Two-dimensional ultrasound is a rapid bedside tool but is highly operator dependent. ObjectiveWe determined three-dimensional ultrasound (3DUS) feasibility, acceptability, and usability in eye pathology detection using the ophthalmologist examination as reference standard. MethodsWe performed a prospective, blinded cohort study of a 3DUS-enabling device in 30 eye clinic and ED patients with visual symptoms and calculated 3DUS performance characteristics. Two expert readers interpreted the 3DUS images for pathology. All participants completed surveys. Results3DUS sensitivity was 0.81, specificity 0.73, positive predictive value 0.54, negative predictive value 0.91, and likelihood ratio (LR)+/LR− 3.03 and 0.26, respectively. Novice and expert sonographers had “substantial” agreement in correct diagnosis of abnormal vs. normal (κ = 0.68, 95% confidence interval 0.48–0.88). Most patients indicated that 3DUS is fast, comfortable, helps them understand their problem, and improves provider interaction/care, and all sonographers agreed; 4/5 sonographers felt confident performing ultrasound. Expert readers correctly identified an abnormal eye in 83/120 scans (76%) and correct diagnosis in 72/120 scans (65%), with no statistical difference between novice (79%; 69%) and expert (72%; 61%) sonographers (p = 0.39, p = 0.55), suggesting reduced operator dependence. Reader diagnosis confidence and image quality varied widely. Image acquisition times were fast for novice (mean 225 ± 83 s) and expert (201 ± 51) sonographers, with fast expert reader interpretation times (225 ± 136). ConclusionsA 3DUS-enabling device demonstrates a sensitivity of 0.81 and specificity of 0.73 for disease detection, fast image acquisition, and may reduce operator dependence for detecting emergent retinal pathologies. Further technological development is needed to improve diagnostic accuracy in identifying and characterizing retinal pathology.

COMMUNITY-BASED EYE HEALTH SCREENING REPORT IN MALAYSIA: URBAN-RURAL REFERRAL COMPARISON

This study compared urban and rural referrals from a community-based eye health screening program named 'Jom Check Mata Malaysia (JCMM)'. The program was carried out in nine different states in Peninsular Malaysia—a total of 18 screening locations with a mix of urban and rural. Two mobile eye clinics were mobilised for community-based eye health screenings. This study involved 3,139 participants (1,158 and 1,981 participants from rural and urban, respectively). Visual complaints were collected via interviews using an ocular symptom checklist. The visual acuity was screened using a Snellen Chart. Ocular health screening, including anterior and posterior eye segments, was screened using slit-lamp bio-microscopy and fundus camera. Overall referrals were 2,139 (68%), 846 (27%) and 362 (12%) based on visual complaints, visual acuity and ocular health screening, respectively. Rural locations had significantly higher referral rates for visual complaint screening (χ2 = 422.53, p&lt;0.05), visual acuity screening (χ2 = 20.20, p&lt;0.05) as well as ocular health screening (χ2 = 64.70, p&lt;0.05) compared to the urban locations. There was a consistent pattern of higher rural referrals for all types of vision screening. Information from our three-category screening analysis could help to design a vision screening for our rural and urban populations.

OCCURRENCE OF GLAUCOMA INCIDENCE AND DIABETES MELLITUS AT KMU MADURA EYE CLINIC

Glaucoma is a disease of the eye characterized by increased intraocular pressure, atrophy of the optic nerve papillae, and reduced vision. Glaucoma can be caused by systemic disease or local disease of the eye. One of the systemic disorders that can trigger glaucoma is diabetes mellitus (DM). The purpose of this study was to determine the relationship between the incidence of glaucoma and a history of diabetes mellitus at the KMU Madura eye clinic. This research was conducted using analytic observational method with a case-control design using a retrospective approach. The sample in this study was obtained by quota sampling technique with a total of 557 patients. Patient data was taken within a period of 12 months from January 2022 – December 2022. Based on the results of observational analysis, it was found that 203 patients (36.44%) had glaucoma with a history of diabetes mellitus, while 354 patients (63.56%) had glaucoma without a history of diabetes mellitus. The results of the Chi-Square test between the prevalence of Glaucoma and a history of Diabetes Mellitus showed a p value = 0.000 (p≤0.05) and the results of the Fisher test between each type of Glaucoma and a history of Diabetes Mellitus only Primary Open Angle Glaucoma only showed there was relationship with the value of p value = 0.004 (p &lt;0.05). The results of this study can be concluded that there is a significant relationship between the prevalence of glaucoma and a history of diabetes mellitus.&#x0D;

Sources of refractive errors in calculating the optical power of intraocular lenses in the treatment of cataract patients

Purpose: Cataract surgery is the most common surgical procedure worldwide, the goal of which is not only to restore the patient’s vision, but to obtain a perfect refractive result that meets the expectations of complete independence from glasses. Unexpected poor refractive outcome after cataract surgery (refractive error) is an unsolved problem, despite increasingly better postoperative outcomes. Improving the postoperative refractive outcome requires an analysis of the sources of refractive errors. This is also the purpose of the present study. Methods: The subject and object of the study were cataract patients with indications for surgical treatment by phacoemulsification (FE) and implantation of an artificial intraocular lens (IOL). The results of the operations of 235 eyes in 160 patients (80 women and 80 men) who underwent surgery in the eye clinic of the Academy of Medical Sciences-Sofia for the period 2018-2020 were analyzed. Results: Of all the measured keratometric parameters, only the value of the cylinder before phacoemulsification is a risk factor, as when it rises above ±1.0D, the risk doubles, and when the value exceeds 2.0D, it becomes 2.4 times greater. The ratio of POC to AL is a statistically significant risk factor for the occurrence of refractive error, with a ratio of POC/AL &lt;0.30, the risk is 2.3 times greater. Conclusion: In the present study, in 62.6% of cases or 2/3 of the eyes, the set Target was successfully met with a minimum permissible refractive error of AE&lt;±0.50D. This determines the effectiveness of the surgical procedure as high.

Thyroid eye disease in pregnant women with Graves disease: Experience from a specialized thyroid eye clinic

Thyroid eye disease in pregnant women with Graves disease: Experience from a specialized thyroid eye clinic

Reading rate of low vision children using optical devices: A pilot study

Background: Visual impairment in children negatively impacts their learning ability compared with their normally sighted peers and the use of optical devices may in turn assist the learner in their educational pursuit.Aim: To determine the reading rate of children with low vision, with and without the use of optical devices.Setting: The study was conducted at an eye clinic in KwaZulu-Natal.Method: A pilot study was conducted on 15 children with low vision, aged between 6 years and 19 years (mean = 13.86 ± 3.34 years). Reading rate was assessed at near, using the English Paediatric Rate of Reading Test, and evaluated with and without the use of optical devices.Results: The mean reading rates were 59.32 word per minute (wpm) ± 24.08 wpm and 67.04 wpm ± 25.63 wpm without and with the optical device, respectively (p = 0.087).Conclusion: While this was a pilot study having implications on statistical significance, the results indicated an improvement in reading rate with optical devices compared with without.Contribution: Vision is integral for the efficient performance of daily tasks. Improved reading performance relates to a happier child despite their visual limitations, hence managing low vision effectively impacts scholarly progression as well as quality of life including physical, mental and social well-being of the child.

It Is All About the Angle: A Clinical and Optical Coherence Tomography Comparison of Corneal Ocular Surface Squamous Neoplasia and Corneal Pannus.

The aim of this study was to compare clinical characteristics and high-resolution optical coherence tomography (HR-OCT) findings between corneal ocular surface squamous neoplasia (OSSN) and corneal pannus. Retrospective study of 9 individuals, 3 with lesions histologically confirmed to be OSSN, 3 with lesions histologically confirmed to be pannus, 1 with lesions histologically confirmed to be OSSN followed by pannus, and 2 with long-standing, nonchanging lesions clinically diagnosed as pannus. All individuals presented to the Miami Veterans Affairs Medical Center eye clinic or Bascom Palmer Eye Institute between 2015 and 2023. Clinical characteristics and HR-OCT findings were evaluated and compared. Mean age of the population was 72.8 ± 5.1 years, 100% self-identified as male, 100% as White, and 11.1% as Hispanic. Clinically, all lesions appeared as whitish, opalescent, variably vascularized opacities extending from the limbus. None of the OSSN cases had vessels that extended to the border, whereas 4 cases of pannus (67%) had at least 1 vessel that reached the border. On HR-OCT, epithelial hyperreflectivity was observed in all cases of OSSN and pannus. Epithelial thickening was observed in all cases of OSSN, but in none of the cases of pannus. An important distinction between the 2 groups was the transition between normal and abnormal epithelium. All cases of OSSN had a vertical transition, whereas all cases of pannus had an angled transition. Corneal OSSN and corneal pannus can both present with clinical findings of an opalescent lesion and may have overlapping findings on HR-OCT. Although both entities may show epithelial hyperreflectivity on HR-OCT, OSSN demonstrates an abrupt transition at a vertical, 90 degrees angle perpendicular to the Bowman layer, whereas pannus appears as an angled transition around 45 degrees. Therefore, the angle of transition between normal and abnormal epithelium can be useful in distinguishing between the 2 entities.

Allogeneic Umbilical Cord Plasma Eyedrops for the Treatment of Recalcitrant Dry Eye Disease Patients.

Dry eye disease is a significant disease in Singapore. While there have been studies using allogenic cord serum for the treatment of dry eye disease, treatment of dry eyes with allogenic umbilical cord plasma drops has yet to be started in Singapore. To evaluate the effectiveness of umbilical cord plasma eyedrops for the treatment of recalcitrant dry eyes in a local Singaporean context. This is an observational, longitudinal, interventional study for dry eye patients who did not show clear improvement after standard therapy. Patients were recruited from 2020 to 2023 from the dry eye clinic of the Singapore National Eye Center. Umbilical cord plasma was delivered frozen to patients and stored in home freezers. All participants underwent a standardized clinical evaluation for dry eye, and data were collected. There were 40 participants (7 males and 33 females). The duration of follow-up was 5.52 ± 1.57 months. Kerato-epitheliopathy staining score, TBUT (tear breakup time), and SPEED (Standard Patient Evaluation of Eye Dryness Questionnaire) scores significantly improved after treatment. No statistically significant improvement was found in terms of visual acuity, according to Schirmer's score. Cord plasma eye drops significantly improved kerato-epitheliopathy staining scores in recalcitrant dry eye patients. Allogeneic plasma is a promising form of treatment for recalcitrant dry eye.

RNA Profiles of Tear Fluid Extracellular Vesicles in Patients with Dry Eye-Related Symptoms.

Currently, diagnosing and stratifying dry eye disease (DED) require multiple tests, motivating interest in a single definitive test. The purpose of this study was to investigate the potential for using tear fluid extracellular vesicle (EV)-RNA in DED diagnostics. With a role in intercellular communication, nanosized EVs facilitate the protected transport of diverse bioactive molecules in biofluids, including tears. Schirmer strips were used to collect tears from 10 patients presenting with dry eye-related symptoms at the Norwegian Dry Eye Clinic. The samples comprised two groups, five from patients with a tear film break-up time (TBUT) of 2 s and five from patients with a TBUT of 10 s. Tear fluid EV-RNA was isolated using a Qiagen exoRNeasy Midi Kit, and the RNA was characterized using Affymetrix ClariomTM D microarrays. The mean signal values of the two groups were compared using a one-way ANOVA. A total of 26,639 different RNA transcripts were identified, comprising both mRNA and ncRNA subtypes. Approximately 6% of transcripts showed statistically significant differential abundance between the two groups. The mRNA sodium channel modifier 1 (SCNM1) was detected at a level 3.8 times lower, and the immature microRNA-130b was detected at a level 1.5 times higher in the group with TBUT 2 s compared to the group with TBUT 10 s. This study demonstrates the potential for using tear fluid EV-RNA in DED diagnostics.

Pituitary Adenoma Hidden by Comorbid Cataract

Background: Background: A pituitary adenoma is an abnormal growth in the pituitary gland. Pituitary adenomas are the most common cause of sellar masses accounting for approximately 10% of all intracranial neoplasms. Early visual symptom of pituitary adenoma can be hidden by comorbid cataract in elderly patients. Case Case Report: Report: A 74 y.o. male presented to the eye clinic with blurry vision at all distances and has trouble with glare from lights. His best corrected visual acuity (BCVA) was 20/20-1 OD, 20/25-2 OS, but subjectively of poor quality. Slit lamp exam confirmed mild nuclear sclerotic cataract OU and normal fundus exam. Patient underwent uncomplicated cataract extraction with intraocular implant, OS first then OD. Post-op course was unremarkable until one month later when patient stated that his vision OS was blurry to the left. BCVA was 20/25 OD, 20/25-2 OS. Post-op exam was still normal including FCF. Humphrey visual field (HVF) however showed a bitemporal hemianopia. Patient was referred for a brain imaging. Brain MRI confirmed a 24 x 22 x 28 mm T2 isointense enhancing mass of the sella with suprasellar extension consistent with a pituitary macroadenoma. Patient underwent endonasal transphenoidal craniectomy for debulking of the tumor subsequently by an ENT specialist. Conclusion Conclusion: Clinicians need to be sure the cataract matches the visual complaint. When in doubt further ancillary testing such as comprehensive HVF is crucial to detect visual pathway disorder and brain tumors. Co-management with corresponding specialist is essential to preserve vision and save life.

Normative Percentiles of Retinal Nerve Fiber Layer Thickness and Glaucomatous Visual Field Loss.

Circumpapillary retinal nerve fiber layer thickness (RNFLT) measurement aids in the clinical diagnosis of glaucoma. Spectral domain optical coherence tomography (SD-OCT) machines measure RNFLT and provide normative color-coded plots. In this retrospective study, we investigate whether normative percentiles of RNFLT (pRNFLT) from Spectralis SD-OCT improve prediction of glaucomatous visual field loss over raw RNFLT. A longitudinal database containing OCT scans and visual fields from Massachusetts Eye & Ear glaucoma clinic patients was generated. Reliable OCT-visual field pairs were selected. Spectralis OCT normative distributions were extracted from machine printouts. Supervised machine learning models compared predictive performance between pRNFLT and raw RNFLT inputs. Regional structure-function associations were assessed with univariate regression to predict mean deviation (MD). Multivariable classification predicted MD, pattern standard deviation, MD change per year, and glaucoma hemifield test. There were 3016 OCT-visual field pairs that met the reliability criteria. Spectralis norms were found to be independent of age, sex, and ocular magnification. Regional analysis showed significant decrease in R2 from pRNFLT models compared to raw RNFLT models in inferotemporal sectors, across multiple regressors. In multivariable classification, there were no significant improvements in area under the curve of receiver operating characteristic curve (ROC-AUC) score with pRNFLT models compared to raw RNFLT models. Our results challenge the assumption that normative percentiles from OCT machines improve prediction of glaucomatous visual field loss. Raw RNFLT alone shows strong prediction, with no models presenting improvement by the manufacturer norms. This may result from insufficient patient stratification in tested norms. Understanding correlation of normative databases to visual function may improve clinical interpretation of OCT data.

The impact of having a free community eye clinic located inside a homeless shelter: a retrospective analysis of patient demographics

Worsening vision is a life-altering process that affects individuals in many aspects of daily life. While worsening vision can be caused by normal physiological processes that occur with age, there can be underlying systemic or ocular diseases that may be the root cause. Routine eye exams can screen for disease as well determine the degree of vision correction required to attain acceptable vision. Access to an eye exam ordinarily requires vision insurance and one must consider the added expense of glasses if they are recommended. While this can be a life-improving visit for many, there are several socioeconomic barriers that discourage homeless and low-income individuals from being able to access this service. The lack of resources to access regular eye exams and the resulting inadequate eye care may lead to underdiagnosis of serious ocular pathology. The Kansas City Free Eye Clinic is located inside a homeless shelter and, therefore, provides a convenient location for homeless and low-income individuals to receive comprehensive eye exams as well as prescription glasses at no cost. In this paper, we discuss the unique setup and demographics of this student-run eye clinic and the ways in which it has served the Kansas City population and how its integration into a homeless shelter could serve as a role model for free community eye clinics.

Barriers and Facilitators to Ophthalmology Visit Adherence in an Urban Hospital Setting.

To explore barriers and facilitators to completing scheduled outpatient appointments at an urban academic hospital-based ophthalmology department. Potential participants were stratified by neighborhood Social Vulnerability Index (SVI) (range, 0-1.0, higher scores indicate greater vulnerability), and semistructured interviews were conducted with individuals 18years and older with an SVI of greater than 0.61 (n = 17) and providers delivering care in the General Eye Clinic of the University of Illinois Chicago (n = 8). Qualitative analysis informed by human-centered design methods was conducted to classify barriers and facilitators into three domains of the Consolidated Framework for Implementation Research: outer setting, inner setting, and characteristics of individuals. There were four main themes-transportation, time burden, social support, and economic situation-all of which were within the outer setting of the Consolidated Framework for Implementation Research; transportation was most salient. Although providers perceived health literacy as a barrier affecting motivation, patients expressed a high motivation to attend visits and felt well-educated about their condition. A lack of resources outside of the health system presents significant barriers for patients from neighborhoods with high SVI. Future efforts to improve adherence should focus on resource-related interventions in the outer setting. Improving access to eye care will require community-level interventions, particularly transportation. Understanding the barriers and facilitators within the Consolidated Framework for Implementation Research provides useful guidance for future interventions, specifically to focus future efforts to improve adherence on resource-related interventions.

Impact of Community Eye Clinics (CEC) on Specialist Eye Clinic Referrals

ABSTRACT Purpose Community Eye Clinics (CEC) increase accessibility of specialist ophthalmic services in the community, reducing demand for tertiary eye services. This paper aims to evaluate the impact of CEC on first-visit referrals from Hougang Polyclinic (HOU) to Tan Tock Seng Hospital Ophthalmology Specialist Outpatient Clinic (SOC). Methods A retrospective analysis was performed on first-visit referrals from Hougang Polyclinic (HOU) to Tan Tock Seng Hospital Ophthalmology Specialist Outpatient Clinic (SOC) over a similar 3-months period before and after the introduction of CEC in August 2018 (1 January to 31 March in 2018 and 2019, respectively). Data pertaining to patients’ presenting complaints, referral reasons, final diagnoses, follow-up plans, and need for ophthalmic intervention were obtained. Results We included 978 patients in our study. There was a 27.5% reduction in the number of first-visit referrals seen at SOC after the establishment of CEC. Patients were more likely to be referred on to sub-specialty eye clinics (10.8% vs. 12.9%, p= p = .304) and receive more ophthalmic interventions (15% vs. 16.3%, p = .066) than prior to CEC. Conclusion The CEC provides greater accessibility to eye care within the community. Optometrists are upskilled to manage patients with stable eye conditions, whilst eye specialists can provide timely care to the SOC for patients with more severe eye conditions.