Eye Doctor Research Articles

The effect of the coronavirus disease 2019 pandemic on ophthalmologic practice from the egyptian population’s point of view

Aim The aim of this study is to understand the impact of COVID 19 on patients’ view of and willingness to seek ophthalmic services in Egypt. It analyzes if there were changes in their eye care habits and under which conditions they would seek advice or undergo elective procedures. Patients and methods It is a cross sectional observational study using a questionnaire that was sent online. The questionnaire included 29 questions. All questions were closed ended questions, provided with a list of optional answers (single answer or multiple answer options). Patients were divided according to age (below 60 years and 60 and above). A follow up survey was done 2 months later and included 13 questions to compare their answers with the initial questionnaire. Results This study included the responses of 596 participants, who answered our questionnaire fully and 198 participants answered the follow-up questionnaire. The vast majority of the participants claimed they would not visit an ophthalmologist during the pandemic, would not undergo any elective surgery and relied on social media for information. On follow- up, the participants were more willing to visit an eye doctor, continue routine follow-ups, took more safety precautions and relied more on medical sources for information. Conclusion Age, contact with vulnerable groups, presence of the chronic diseases and duration of the pandemic significantly affect the patients’ willingness to seek ophthalmic services. Changes in populations’ information and doctor practice are needed in this pandemic.

Take the eye doctor's headache seriously and do not reduce it to tension-type headache.

Take the eye doctor's headache seriously and do not reduce it to tension-type headache.

Rancang Bangun Expert System Diagnosa Penyakit Mata Manusia Menggunakan Metode Certainty Factor

When the eyes experience interference, the sufferer will be very uncomfortable in doing their daily activities. In an expert system, the Certainty Factor methods are used to determine the percentage of possible eye diseases suffered and provide accurate diagnostic information based on research conducted. The expert system developed to diagnose eye disease has been successfully implemented using knowledge which includes 22 symptoms and 6 types of related diseases. The purpose of this study is to explore the symptoms displayed in the form of questions in order to diagnose the type of disease with web management system-based software. So that later it gives the results of the percentage of diagnosis of eye disease after based on the symptoms suffered. Of course this research can help experts in dealing with existing problems and make it easier for the general public to get information about eye diseases directly consult through the system without having to check with an eye doctor first, can also provide relief for the underprivileged people who want to consult directly with experts only through Web application.

COMMEMORATING AS CRITICIZING: HOW LI WENLIANG’S WEIBO HOMEPAGE BECOMES A PLACE FOR QUESTIONING CHINA’S COVID-19 POLICIES AND A “WAILING WALL”

Li Wenliang, an eye doctor at Wuhan Central hospital and one of the first to raise alarm about the outbreak of COVID-19, was summoned by the local police and forced to sign a statement reprimanding his message as a groundless rumor as well as a disturbance to the public order in late December 2019. Two months later, Li died after contracting COVID-19 at his workplace, aged 33 years. This caused shock and outrage across China and Li’s Weibo (China’s equivalent of Twitter) homepage soon became an online “wailing wall,” where people mourned, condoled, and commemorated the whistleblower and complained, questioned, and protested the overstrict government policies relevant to COVID-19 pandemic. This study shows that Weibo offers a place for users to see the mundane life of Li Wenliang, express grief and frustration, and interact with each other to remember Li, whereas another super-powerful Chinese social media, WeChat, allows users to synthesize information about Li, provide analysis and criticism, and circulate the memory of Li through their social networks. Together, these two platforms helped stabilize Chinese internet users’ memory of Li as a whistleblower, a civilian hero, a martyr, and a supporter of free speech and diverse voices, distinguished from the official version. This study contributes to recent scholarly interest in understanding how the technological affordances of social media shape memory work. It also shows that even in a politically constrictive environment, such as China’s media ecology, the space for questioning and protesting still exists, though more nuanced and precarious.

ASSOCIATION OF DRY EYES ON SMOKING HABITS: A SYSTEMATIC REVIEW

Introduction: Dry eye disease (DED), dry eye syndrome, and keratoconjunctivitis sicca (KCS) are typical reasons for eye doctor visits. Smoking's effect on DED is yet unknown, and there is conflicting evidence. Several factors contributed to this outcome, including the studies' limited sample sizes, the imbalance of components between cases and controls, and the ambiguous smoking status classification. This article shows a link between smoking and dry eye condition. The aim: This piece of writing provides evidence that demonstrates a connection between smoking and dry eye diseases. Methods: For this systematic review, publications that were published from 2013 to 2023 were taken into account during the search process. This was achieved through the utilization of numerous online reference sources, such as Pubmed and SagePub. The decision was made to exclude review articles, previously published works, and incomplete works. Result: We found 92 articles from PubMed and 107 articles from SagePub, for which title and abstract analysis was carried out. We found 23 relevant articles. We found 11 studies demonstrates a connection between smoking and dry eye diseases. Conclusion: Smoking may not cause DED. The risk of smoking and DED is still debated due to inconsistent findings.

Association of Sociodemographic Characteristics with Pediatric Vision Screening and Eye Care: An Analysis of the 2021 National Survey of Children's Health

ObjectiveVision screening and regular eye care can help to detect and treat potentially irreversible vision impairment. This study aims to investigate the associations between sociodemographic and health characteristics and the receipt of eye care among children aged 17 and under in the United States. DesignThis cross-sectional study used data from the National Survey of Children's Health, a nationally representative and population-based survey of randomly sampled households. ParticipantsParticipants were children aged 0 to 17 years old, residing in all 50 states and the District of Columbia, whose caregivers or parents answered an address-based survey by mail or online. MethodsWeighted prevalence calculations were applied to analyze the data, and logistic regression was performed to explore associations between reported eye care and demographic, health, and parent-related variables. Main outcomes and measuresCaregiver-reported vision screenings, referral to an eye doctor after vision screening, eye doctor visits, and prescription of corrective lenses. ResultsCaregivers reported that 53.2% of children had a vision screening at least once (if child ≤ 5 years) or within the past 2 years (if child > 5 years). Of those screened, 26.9% were referred to an eye doctor. Overall, 38.6% of all children had a previous eye doctor visit, and among them, 55.4% were prescribed corrective lenses during the visit. Factors associated with decreased odds of vision screening included younger age, lack of health care visits, no insurance coverage, parent education ≤ high school, and lower household income. Non-White ethnicities, households with a non-English primary language, and lower incomes were more likely to be referred to an eye doctor after vision screening. Lower rates of eye doctor visits were associated with younger age, lack of insurance coverage, and primary household languages other than English. ConclusionsChildren from disadvantaged backgrounds are less likely to receive vision screening and eye care. Targeted strategies are needed to increase vision screening and access to eye care services in these vulnerable groups.

Myopia: An alarming situation in near future

Madam, I am writing to draw attention to an issue that I believe is of great concern for our society: the alarming increase in cases of myopia due to excessive near work. Myopia, or nearsightedness, when the eye has difficulty focusing on distant objects. The prevalence of myopia has been increasing rapidly worldwide, particularly in Asia, where it is estimated that up to 80% of young adults are affected. In the United States, the prevalence of myopia has doubled in the past 30 years.[1] One major factor contributing to this increase is the growing amount of time people spend near work, such as reading, using computers, and playing video games. This kind of work requires the eyes to focus on close objects for extended periods, which can cause the eye to elongate and result in myopia. The consequences of myopia are not only visual but also have significant impacts on quality of life. Myopia increases the risk of eye diseases such as glaucoma, cataracts, and retinal detachment, which can lead to blindness. It can also have a negative impact on academic and career opportunities, as well as physical and social activities. [2] Get regular eye exams: Regular eye exams are crucial for detecting myopia early and monitoring its progression. It is recommended that infants have their first eye exam at six months, and then again at the ages of three and five, and every two years after that. Adults should have an eye exam at least once every two years, or more frequently if advised by their eye doctor. Practice good visual habits: Good visual habits can help prevent myopia from worsening. This includes taking frequent breaks when reading or using electronic devices, maintaining a comfortable distance from the screen, and practicing good posture. You can also try doing eye exercises to strengthen your eye muscles. Spend time outdoors: Studies have shown that spending time outdoors, especially in natural light, can help prevent the onset and progression of myopia in children. Aim for at least 2 hours of outdoor time per day. A study by David A Wilson et al. showed that by 2050 there will be 1 billion people with myopia.[3] Nowadays, our young generation is executively using smartphones and digital screens. All ophthalmologist and optometrist are advised to know all the clints regarding close work to rest in between your work. ---Continue

Association between dietary antioxidant indices and glaucoma in the National Health and Nutrition Examination Survey

ObjectiveTo explore the relationship between dietary antioxidant indices (DAI) and glaucoma using the data from the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES).MethodsOur study comprised participants who completed the NHANES dietary intake interview and visual health questionnaire at age 40 or older. The intakes of the vitamins A, C, and E as well as of zinc, selenium, and magnesium were used to generate the DAI, which represents the overall antioxidant qualities. The self-report method for glaucoma diagnosis (ever been told by an eye doctor) was used. Survey logistic regression analyses were employed to investigate the association between DAI and glaucoma.ResultsA total of 6,128 participants were included in our study. The unadjusted model’s findings revealed a negative correlation between dietary antioxidant indices and self-reported glaucoma [0.93 (0.90, 0.96), p < 0.0001]. For every unit increase in dietary antioxidant indices, the risks of self-reported glaucoma in model 1 (adjusted for age, sex, race, marital status and PIR) decreased by 5% [0.95 (0.90, 0.99), p = 0.02]. After adjusting all the covariates (model 2), the risks of self-reported glaucoma decreased by 6% [0.94 (0.90, 0.99), p = 0.02] for each unit increase of dietary antioxidant indices. After converting DAI into classified variables (tertile), the same trend was found (p = 0.001).ConclusionIn this analysis of the NHANES database, we found higher dietary antioxidant indices were associated with lower risk of glaucoma.

ChatGPT: is it good for our glaucoma patients?

PurposeOur study investigates ChatGPT and its ability to communicate with glaucoma patients.MethodsWe inputted eight glaucoma-related questions/topics found on the American Academy of Ophthalmology (AAO)’s website into ChatGPT. We used the Flesch–Kincaid test, Gunning Fog Index, SMOG Index, and Dale–Chall readability formula to evaluate the comprehensibility of its responses for patients. ChatGPT’s answers were compared with those found on the AAO’s website.ResultsChatGPT’s responses required reading comprehension of a higher grade level (average = grade 12.5 ± 1.6) than that of the text on the AAO’s website (average = 9.4 grade ± 3.5), (0.0384). For the eight responses, the key ophthalmic terms appeared 34 out of 86 times in the ChatGPT responses vs. 86 out of 86 times in the text on the AAO’s website. The term “eye doctor” appeared once in the ChatGPT text, but the formal term “ophthalmologist” did not appear. The term “ophthalmologist” appears 26 times on the AAO’s website. The word counts of the answers produced by ChatGPT and those on the AAO’s website were similar (p = 0.571), with phrases of a homogenous length.ConclusionChatGPT trains on the texts, phrases, and algorithms inputted by software engineers. As ophthalmologists, through our websites and journals, we should consider encoding the phrase “see an ophthalmologist”. Our medical assistants should sit with patients during their appointments to ensure that the text is accurate and that they fully comprehend its meaning. ChatGPT is effective for providing general information such as definitions or potential treatment options for glaucoma. However, ChatGPT has a tendency toward repetitive answers and, due to their elevated readability scores, these could be too difficult for a patient to read.

A-355 Eyescore, A Point of Care Smartphone App for Early Dry Eye Diagnosis and Management

Abstract Current diagnosis of dry eye disease (DED) has significant challenges with limited accuracy and poor correlation of clinical symptoms. The goal of this study is to develop a smartphone App, namely “EyeScore”, to provide a point of care (POC) and digital solution for early diagnosis of DED. The authors tested the hypothesis of measuring eye blink rate and partial blink count as early clinical biomarkers for the calculation of so called “eye healthiness score”, which allows a convenient, rapid eye exam at home with low resource settings. EyeScore uses an iPhone as an imaging and sensing device for in-App recordings of eyelid movements. The use of facial landmark recognition and eye aspect ratio (EAR) enabled comprehensive digital analysis of video frames for determination of the eye opening/closed states. The smartphone videos from 10 DED patients and 10 healthy controls were tested to optimize EAR derived thresholds for accurate measurements of blink rates and partial blink counts. The authors formulated a clinically relevant algorithm for the calculation of “eye healthiness score”. This 10-point scale score can be easily measured anytime with a non-invasive manner and remotely shared with the patient's eye doctor. As a result, both patients and doctors can monitor the eye conditions over time. Our results showed that EyeScore confirmed the diagnosis of all 10 DED patients. Importantly, Eyescore also identified three individuals with “pre-DED” conditions from 10 healthy controls, demonstrating its potential clinical values for early diagnosis and management of DED. Materials and Methods An Apple MacBook Pro installed with iOS software (iOS 16.1.2) and Xcode 14.0 was used for coding and debugging. Visionkit SDK from Apple Developer was adopted to extract coordinate data from six eye facial landmarks. EAR values were calculated based on the previously published formula, with a dynamic EAR developed as a threshold for the measurement of blink rate and half blink count. For eye healthiness score, a 10-point formula was formulated (0–3, normal; 4–5, Pre-DED; 6–10, DED) with several contributing factors including blink rate, half blink count, eye discomfort and demographic characteristics. Results A total of 20 iPhone videos from DED patients and healthy controls were analyzed and evaluated with EyeScore App. All DED patients obtained scores above 7, confirming their DED diagnosis. On the other hand, three controls obtained scores of 4 or 5, suggesting they were in the Pre-DED state with no noticeable clinical DED symptoms. All other controls obtain scores blow 3 with normal eye conditions. All tests were performed with the consents from the test participants. Conclusions Smart phone-based platform offers great potentials for point of care diagnostic methods. A POC enabled EyeScore App has been successfully developed for early diagnosis of DED. In the future, the authors plan to test EyeScore with a large-scale sample set of DED patients and controls to further validate the accuracy and predictability of eye healthiness score for its broader clinical applications.

School-Based Health Centers, Access to Care, and Income-Based Disparities

School-based health centers (SBHCs) are primary care clinics colocated at schools. SBHCs have the potential to improve health care access and reduce disparities, but there is limited rigorous evidence on their effectiveness at the national level. To determine whether county-level adoption of SBHCs was associated with access, utilization, and health among children from low-income families and to measure reductions in income-based disparities. This survey study used a difference-in-differences design and data from a nationally representative sample of children in the US merged with SBHC indicators from the National Census of School-Based Health Centers. The main sample included children aged 5 to 17 years with family incomes that were less than 200% of the federal poverty level observed in the National Health Interview Survey, collected between 1997 to 2018. The sample was restricted to children living in a county that adopted a center between 2003 and 2013 or that did not have a center at any time during the study period. Analyses of income-based disparities included children from higher income families (ie, 200% or higher than the federal poverty level). Data were analyzed between January 2020 and July 2023. County-by-year SBHC adoption. Outcomes included access (usual source of care, insurance status, barriers), ambulatory care use (general physician, eye doctor, dental, mental health visits), and health (general health status, missed school days due to illness). P values were adjusted for multiple comparisons using the sharpened q value method. This study included 12 624 unweighted children from low-income families and 24 631 unweighted children from higher income families. The weighted percentage of children in low-income families who resided in counties with SBHC adoption included 50.0% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 36.7% Hispanic children, 25.2% non-Hispanic Black children, and 30.6% non-Hispanic White children. The weighted percentages of children in the counties that never adopted SBHCs included 50.1% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 20.7% Hispanic children, 22.4% non-Hispanic Black children, and 52.9% non-Hispanic White children. SBHC adoption was associated with a 6.4 percentage point increase in dental visits (95% CI, 3.2-9.6 percentage points; P < .001), an 8.0 percentage point increase in having a usual source of care (95% CI, 4.5-11.5 percentage points; P < .001), and a 5.2 percentage point increase in insurance (95% CI, 1.2-9.2 percentage points; P = .03). No other statistically significant associations were found with other outcomes. SBHCs were associated with relative reductions in income-based disparities to dental visits by 76% (4.9 percentage points; 95% CI, 2.0-7.7 percentage points), to insured status by 63% (3.5 percentage points; 95% CI, 1.3-5.7 percentage points), and to having a usual source of care by 98% (7.2 percentage points; 95% CI, 5.4-9.1 percentage points). In this survey study with difference-in-differences analysis of SBHC adoption, SBHCs were associated with access to care and reduced income-based disparities. These findings support additional SBHC expansion.

Perspectives on Adherence to Glaucoma Medical Therapy in Brazilian Patients.

Poor adherence to glaucoma medication regimens may be associated with subsequent optic nerve damage and irreversible visual loss. Specific barriers to effective patient adherence in low-middle income countries are not fully recognized and new disease-specific instruments to assess adherence have been developed. The purpose of this cross-sectional study was to evaluate adherence of primary open-angle glaucoma (POAG) patients to treatment in a middle-income country. POAG patients were recruited from the Glaucoma Service - Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil. Clinical and demographic data were retrieved from participants' electronic records. All patients answered the Glaucoma Treatment Compliance Assessment Tool (GTCAT). This 27-item questionnaire was designed to evaluate multiple behavioral factors associated with glaucoma medication adherence. The sample comprised 96 patients with POAG. The mean age was 63.2 ± 8.9 years; 48 were male and 48 female; 55 (57.3%) were White, 36 (37.5%) African-Brazilian, and five (5.2 %) were of mixed color. Most patients (97.9%) had less than a high school degree and all had a family income <US$10,000. The GTCAT identified 69 (71.8%) patients who "sometimes forget to use drops," 68 (70.8%) patients who "sometimes fall asleep before dosing time," and 60 (62.5%) patients "whose drops aren't with them at the time to take them"; 82 (85.4%) patients admitted to using "reminders to take medications." Eighty-two (85.4%) patients agreed that "doctor answers my questions," and 77 (80.5%) said "they are happy with their eye doctor." The GTCAT identified a number of mostly unintentional factors associated with adherence in this cohort of Brazilian patients. The data may impact on how to understand and improve adherence to ocular hypotensive treatment in the Brazilian population.

A REVIEW ON POLYCORIA

The presence of multiple iris holes is most commonly called pseudopolycoria, because only the central pupil has a sphincter muscle and can constrict. Iris holes without muscle tissue arise as congenital defects or develop from ocular trauma, inflammation, or degeneration and are thus not considered to be true accessory pupils. Multiple pupils, also known as true polycoria, are distinguished by the presence of a sphincter muscle around each iris hole, permitting synchronous constriction and dilation of the 2 pupils. One presumed mechanism for polycoria is a snaring or pinching off from the margin of another pupil. This patient had a small, oval-shaped accessory pupil, which may have separated from the temporal margin of the central pupil, leaving a thin bridge of no sphincter connecting tissue. The outlook for polycoria is generally good. You may not require any treatment if your visual impairment is minimal and doesn’t interfere with your daily life. However, if treatment is needed, pupilloplasty has so far shown positive results. If you have polycoria, it’s important to have regular check-ups with an eye doctor to monitor your vision and any changes your eyes may have. Having your eye checked regularly is also beneficial for your eyesight as a whole.

Sjogren's Syndrome: Multidisciplinary Approach to Diagnosis and Management

Purpose: Sjögren’s syndrome (SS) is a chronic and progressive multisystem autoimmune disease typically managed by rheumatologists. Diagnostic delays are common, due in large part to the non-specific and variable nature of SS symptoms and the slow progression of disease.&#x0D; Methodology: This article reviews current understanding of the clinical manifestations, diagnosis and treatment of Sjögren's syndrome and its attendant ocular manifestation. Sjögren's syndrome is a chronic inflammatory disorder of the exocrine glands with multiple non exocrine features. It is found predominantly in middle-aged women but exists throughout the population. The diagnosis of Sjögren's syndrome can be challenging because the cardinal sicca symptoms may be subclinical or attributed to other causes, such as medications or aging. Differential diagnosis of Sjögren's syndrome can be confounded by the multiple exocrine manifestations in the mouth, eyes, ears, nose, skin, vagina, and respiratory and gastrointestinal tracts. Characteristics of SS are dry eye and dry mouth, which are typically the earliest presenting complaints, eye care clinicians such as the optometrists and dental professionals are often the first point of medical contact and can provide critical collaboration with rheumatologists to facilitate both timely diagnosis and ongoing care of patients with SS.&#x0D; Findings: Current diagnostic criteria advocated by the American College of Rheumatology are predicated on the presence of signs/symptoms suggestive of SS along with at least two objective factors such as traditional biomarker positivity, salivary gland biopsy findings, and/or presence of keratoconjunctivitis sicca. Timely diagnosis of SS requires appropriate clinical vigilance for potential SS symptoms, referral and collaborative communication among rheumatology, optometrists, ophthalmology, and oral care professions.&#x0D; Unique Contribution to Theory, Practice and Policy: It is concluded that optometrists can now identify Sjogren’s patients earlier in their dry eye population with a new advanced diagnostic test Sjo,the laboratory test designed for early detection of Sjogren’s syndrome, has been available from Nicox for use by eye care professionals since November,2013. Optometrists have a role to play in the management of ocular manifestations of Sjogren’s syndrome. Such symptoms can lead to discomfort, blurred vision, and visual fatigue if not attended to immediately.&#x0D; For people with immune system disorder, inflammation of tear-secreting glands reduces tear production, resulting in chronic dry eyes. Prescription eye drops such as Tears Naturale, Cyclosporine (Restasis) or Lifetegrast(Xiidra) may be recommended by the eye doctor if you have moderate to severe dry eyes.

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.

Associations Between Thyroid Eye Disease and Glaucoma Among Those Enrolled in the National Institutes of Health All of Us Research Program.

To assess the association between thyroid eye disease (TED) and glaucoma. Patients 18 years of age and over enrolled in the NIH All of Us Research Program, a nationwide cohort, were extracted. Those with conditions relating to TED were identified and compared with 2020 US Census-matched controls without a diagnosis of TED in a 1:4 ratio. The authors used Pearson's χ 2 tests to study demographics by TED status, and logistic regression to generate odds ratios and 95% confidence intervals to evaluate the association between TED and glaucoma (any type, including glaucoma suspect), using those without TED as the reference group. Multivariable models were adjusted for age, gender, race/ethnicity, eye doctor visits, and smoking status. A total of 393 cases of TED and 1,572 US Census-matched controls were identified. The median age of the cohort was 63 years (interquartile range: 48-73 years). Age, gender, and race/ethnicity varied by TED status ( p < 0.001). Overall, 114 (29.0%) of TED cases had a diagnosis of glaucoma, compared with 94 (6.0%) of non-TED controls. On bivariate logistic regression models, those diagnosed with TED were significantly more likely to be diagnosed with glaucoma compared with controls (odds ratio: 6.42; 95% confidence interval: 4.76-8.70; p < 0.001). This trend persisted on multivariable logistic regression controlling for confounding factors (odds ratio: 3.37; 95% confidence interval: 1.85-6.20 p < 0.001). Individuals with TED were significantly more likely to be diagnosed with glaucoma. Clinicians caring for patients with TED should be aware of this elevated risk and arrange glaucoma evaluation, accordingly.

A Geographic Analysis of Google Characterizations of Who Is an "Eye Doctor" Across the US

In order to continue to clarify and maintain their role as eye physicians and surgeons, ophthalmologists may want to understand how they are viewed in the public eye and online. To determine the representation of ophthalmologists (OMD) and optometrists (ODs) when a Google search for "eye doctor near me" is made from each county in the US. This population-based cross-sectional study used publicly available data on OMDs and ODs and a Google search application programming interface (API) to search the phrase "eye doctor near me" from the geographic coordinates of each county centroid in the US (searched June 30, 2021). The top 10 sites and 3 Google map links, excluding physician ratings sites, were recorded. Data from the US Centers for Medicare and Medicaid Services were used to estimate the real number of OMDs and ODs per county. The primary outcome was the mean proportion of OMDs listed by Google search as compared with the real proportion of OMDs for the US overall and for each state and county. A total of 2955 counties from 52 states and territories were included. The overall mean proportion of OMDs (OMDs with ODs) from the Google search of all counties was 4726.97 of 16 345.93 (28.91%), which was also less than the real proportion of ODs (15 778 of 41 975 [37.58%], a difference of 8.67%; 95% CI, 37.13-38.05%; P < .001). OMDs were underrepresented by Google in 35 of 52 states and territories (67.3%). In most counties in the US, Google search of the phrase "eye doctor near me" may underrepresent ophthalmologists. Ophthalmologists may want to pursue search engine optimization to try to achieve balanced representation online.

Ensuring Equitable Care in Diabetes Management Among Patients of Health Resources & Services Administration-Funded Health Centers in the United States.

To explore whether there are racial/ethnic differences in diabetes management and outcomes among adult health center (HC) patients with type 2 diabetes. We analyzed data from the 2014 Health Center Patient Survey, a national sample of HC patients. We examined indicators of diabetes monitoring (A1C testing, annual foot/eye doctor visits, and cholesterol checks) and care management (specialist referrals, individual treatment plan, and receipt of calls/appointments/home visits). We also examined diabetes-specific outcomes (blood glucose levels, diabetes-related emergency department [ED] visits/hospitalizations, and diabetes self-management confidence) and general outcomes (number of doctor visits, ED visits, and hospitalizations). We used multilevel logistic regression models to examine racial/ethnic disparities by the above indicators. We found racial/ethnic parity in A1C testing, eye doctor visits, and diabetes-specific outcomes. However, Hispanics/Latinos (odds ratio [OR] 0.26), non-Hispanic African Americans (OR 0.25), and Asians (OR 0.11) were less likely to receive a cholesterol check than Whites. Non-Hispanic African Americans (OR 0.43) were less likely to have frequent doctor visits, while Hispanic/Latino patients (OR 0.45) were less likely to receive an individual treatment plan. HCs largely provide equitable diabetes care but have room for improvement in some indicators. Tailored efforts such as culturally competent care and health education for some racial/ethnic groups may be needed to improve diabetes management and outcomes.

Blues

A woman who works as a museum curator and is organizing a new exhibition, starts crying blue and goes to an eye doctor's clinic hoping to find a cure for her ailment.

Healthcare Access and Utilization Among Glaucoma Patients in a Nationwide Cohort.

Despite having lower socioeconomic status on several measures, glaucoma patients do not report more barriers to healthcare access and utilization than non-glaucoma patients. To characterize measures of socioeconomic status and barriers to healthcare access and utilization between patients with and without a diagnosis of glaucoma. Patients aged 65 years and over who enrolled in the NIH All of Us Research Program, a nationwide longitudinal cohort, were extracted. We analyzed demographic information and several measures of socioeconomic status and healthcare access and utilization. Survey responses were compared by glaucoma status (any type) with Pearson χ 2 tests, univariable logistic regression, and multivariable logistic regression adjusting for age, gender, race/ethnicity, and insurance status. Of the 49,487 patients who answered at least 1 question on the All of Us Healthcare Access and Utilization Survey, 4441 (9.0%) had a diagnosis of glaucoma. Majority of the cohort was female (28,162, 56.9%) and nonHispanic White (42,008, 84.9%). Glaucoma patients were observed to have lower rates of education ( P =0.004), employment ( P <0.001), and home ownership ( P <0.001) on χ 2 tests. On multivariable logistic regression models, those with glaucoma were significantly more likely to speak to an eye doctor (Odds ratio: 2.46; 95% confidence interval: 2.16 to 2.81) and significantly less likely to have trouble affording eyeglasses (OR: 0.85 95% CI: 0.72 to 0.99) in the prior year than those without a diagnosis of glaucoma. No significant association was found for other measures of healthcare access and utilization by glaucoma status. Although glaucoma patients aged 65 years and over fared worse on several measures of socioeconomic status, no significant difference was found in measures of healthcare access and utilization.