General Eye Care Research Articles

Understanding Health Care Disparities Based on Medicare Use for Inflammatory and Infectious Eye Diseases.

Inflammatory and infectious eye diseases are an important cause of visual impairment in patients older than 65 years of age. Health care disparities for eye care are present for general eye care. However, there is lack of national data on health disparities regarding eye care use for inflammatory and infectious eye diseases. Our study examines the effect of gender and race on eye care in patients with inflammatory and infectious eye diseases who are equal or greater than 65 years of age. We have used Medicare data to examine the effect gender and race on use of eye care services in patients with inflammatory and infectious eye diseases for 2014 to 2018. Medicare is a national insurance program administered by the government of United States to insure people age 65 years or older. Owing to its high enrollment, those in Medicare are representative of the U.S. population aged 65 and older. We found that females have higher use for Medicare for inflammatory and infectious eye diseases across all races from 2014 to 2018. On examining the effect of race, African Americans have lower use as compared with Whites. People of Asian descent have the highest use, followed by Hispanic people. Health care disparities exist for eye care use for inflammatory and infectious eye diseases for patients 65 years of age and older. Future studies are required to address these disparities to provide equitable eye care. Identification of eye care disparities is the first step to addressing these disparities.

A Systematic Review of Teleophthalmology Services Post-COVID-19 Pandemic in New Zealand, the United Kingdom, Australia, the United States of America, and Canada.

Background: This systematic review of teleophthalmology services in Australia, the United States of America (USA), Canada, and the United Kingdom (UK) during the COVID-19 pandemic is aimed to evaluate changes in teleophthalmology, comparing them to New Zealand (NZ). Methods: A literature search of electronic databases Scopus, Proquest, PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, and Google was conducted using search terms: telemedicine, ophthalmology, teleophthalmology/teleophthalmology, and COVID/COVID-19/coronavirus/covid-pandemic. Studies describing teleophthalmology services created in response to COVID-19 restrictions from March 1, 2020, to January 31, 2024, were analyzed. Results: Of the articles, 37 describing 29 discrete teleophthalmology services were included. There were 15 services in the USA, seven in the UK, two in Canada, two in Australia, and three in NZ. The models of care in the USA were well described, and teleophthalmology was used for general, external, anterior segment, neuro-ophthalmology, and oculoplastic consults, as well as for grading of fundus images in the emergency department setting. In the UK, teleophthalmology was used for general eye care, oculoplastics, and pediatric ophthalmology. In Australia, teleophthalmology was used for postglaucoma surgery monitoring of Intraocular Pressure. In NZ, teleophthalmology was used for general eye consults and triaging, but no formal models were described. Conclusion: COVID-19 offered a unique opportunity for re-examination and expansion of teleophthalmology services globally. Video-based and home-screening teleophthalmology services are feasible but have limitations. Investing in multidisciplinary and community-based technology partnerships can create more equitable teleophthalmology care models (to complement and, when necessary, replace traditional in-person consults), within existing frameworks, making eye care more accessible and efficient.

COVID-19 and Nursing Care of Ophthalmic Patients During Pandemic

Background: The corona virus, a novel, enveloped single stranded RNA virus (sarscOv-2) which has mainly affected respiratory system with life threatening results. The SARS-CoV-2 has been detected in several body fluids including tear and discharge of patients suffering from conjunctivitis. The aim of this paper is to explore the nursing care of person with ophthalmic problems.
 Methods: A literature review was conducted using data based of Google scholar, Google, Pubmed, Medline since 2015-2023.
 Results: An ophthalmic nurse can play a key role in teaching a patient and their attendants about general eye care and protection of vision during COVID-19 monitoring the patient’s condition, as well as ophthalmic instruments after it’s use have been are two main responsibilities of the nurse working in the ophthalmic units. Nurses also have responsibilities to maintain the safe and clean working environment of the unit, making the environment clean and safe.
 Conclusion: The environment of the eye ward must be clean, safe and free from organism. A nurse should warn the patients not to touch or rub the eyes and dressings or eye shields with unprotected hand during this COVID-19 pandemic.

Detection of signs of disease in external photographs of the eyes via deep learning.

Retinal fundus photographs can be used to detect a range of retinal conditions. Here we show that deep-learning models trained instead on external photographs of the eyes can be used to detect diabetic retinopathy (DR), diabetic macular oedema and poor blood glucose control. We developed the models using eye photographs from 145,832 patients with diabetes from 301 DR screening sites and evaluated the models on four tasks and four validation datasets with a total of 48,644 patients from 198 additional screening sites. For all four tasks, the predictive performance of the deep-learning models was significantly higher than the performance of logistic regression models using self-reported demographic and medical history data, and the predictions generalized to patients with dilated pupils, to patients from a different DR screening programme and to a general eye care programme that included diabetics and non-diabetics. We also explored the use of the deep-learning models for the detection of elevated lipid levels. The utility of external eye photographs for the diagnosis and management of diseases should be further validated with images from different cameras and patient populations.

A Systematic Review of Current Teleophthalmology Services in New Zealand Compared to the Four Comparable Countries of the United Kingdom, Australia, United States of America (USA) and Canada.

BackgroundOver 700,000 New Zealanders (NZ), particularly elderly and Māori, live without timely access to specialist ophthalmology services. Teleophthalmology is a widely recognised tool that can assist in overcoming resource and distance barriers. Teleophthalmology gained unprecedented traction in NZ during the COVID-19 pandemic and subsequent lockdown. However, its provision is still limited and there are equity issues. The aim of this study was to conduct a systematic review identifying, describing and contrasting teleophthalmology services in NZ with the comparable countries of Australia, USA, Canada and the United Kingdom.MethodsThe electronic databases Embase, PubMed, Web of Science, Google Scholar and Google were systemically searched using the keywords: telemedicine, ophthalmology, tele-ophthalmology/teleophthalmology. The searches were filtered to the countries above, with no time constraints. An integrative approach was used to synthesise findings.ResultsOne hundred and thirty-two studies were identified describing 90 discrete teleophthalmology services. Articles spanned from 1997 to 2020. Models were categorised into general eye care (n=21; 16%); emergency/trauma (n=6; 4.5%); school screening (n=25; 19%); artificial intelligence (AI) (n=23; 18%); and disease-specific models of care (MOC) (n=57; 43%). The most common diseases addressed were diabetic retinopathy (n=23; 17%); retinopathy of prematurity (n=9; 7%); and glaucoma (n=8; 6%). Programs were mainly centred in the US (n=72; 54.5%), followed by the UK (n=29; 22%), then Canada (n=16; 12%), Australia (n=13; 10%), with the fewest identified in NZ (n=3; 2%). Models generally involved an ophthalmologist consultative service, remote supervision and triaging. Most models involved local clinicians transmitting fed-forward or live images.ConclusionTeleophthalmology will likely play a crucial role in the future of eye care. COVID-19 has offered a unique opportunity to observe the use of teleophthalmology services globally. Feed-forward and, increasingly, live-based teleophthalmology services have demonstrated feasibility and cost-effectiveness in similar countries internationally. New Zealand’s teleophthalmology services, however, are currently limited. Investing in strategic partnerships and technology at a national level can advance health equities in ophthalmic care.

Models of care in tele-ophthalmology: A scoping review

The objective of this review was to identify and describe telehealth models of care for ophthalmic services. We conducted a scoping review of the literature to identify how ophthalmic care can be delivered by telehealth. We searched the PubMed database to identify relevant articles which were screened based on pre-defined inclusion criteria. For included articles, data were extracted, categorised and analysed. Synthesis of findings was performed narratively. The scoping review included 78 articles describing 62 discrete tele-ophthalmic models of care. Tele-ophthalmic models of care can be used for consultative service, screening, triage and remote supervision. The majority of services were for general eye care and triage (n = 17; 26%) or emergency services (n = 8; 12%). The most common conditions for disease-specific models of care were diabetic retinopathy (n = 14; 21%), and glaucoma (n = 8; 12%). Most models of care involved local clinicians capturing images and transmitting them to an ophthalmologist for assessment. This scoping review demonstrated tele-ophthalmology to be feasible for consultation, screening, triage and remote supervision applications across a broad range of ophthalmic conditions. A large number of models of care have been identified and described in this review. Considerable collaboration between patient-end clinicians and substantial infrastructure is typically required for tele-ophthalmology.

Clinical Characteristics of Acanthamoeba Keratitis Infections in 28 States, 2008 to 2011

The aim was to describe a geographically and clinically diverse sample of cases of Acanthamoeba keratitis (AK) and establish the risk factors for poor outcomes among patients with this disease. We conducted a retrospective, population-based case series of 116 patients with AK identified through a national surveillance network. Data were collected via a medical record review by diagnosing ophthalmologists and by phone interviews with patients. Exact logistic regression modeling was used to determine risk factors for poor visual outcomes. Among patients with data available on contact lens use, it was found that 93.3% wore contact lenses. The median time from symptom onset to care seeking was 2 days, whereas the median time from symptom onset to diagnosis was 27 days. Keratoplasty was performed in 27 of 81 patients with available outcome data and was more likely in patients >40 years old [odds ratio (OR) 5.25, 95% confidence interval (CI) 1.49-21.92]. When adjusted for age, the risk factors for keratoplasty included the presence of a ring infiltrate (OR 40.00, 95% CI 3.58-447.0) or any sign of stromal invasion (OR 10.48, 95% CI 2.56-55.09). One-third of patients with available data on best-corrected visual acuity had a best-corrected visual acuity <20/200, with the presence of a ring infiltrate as the only significant predictor of this outcome when adjusted for age (aOR 3.45, 95% CI 1.01-12.31). AK remains challenging to diagnose. Consequently, patients with advanced disease are more likely to have poor outcomes, particularly if they are older. The increasing awareness of AK among general eye care providers may shorten referral times and potentially improve outcomes.

Making a difference with Vision 2020: The Right to Sight? Lessons from two states of North Western Nigeria.

Settings and Aim: The World Health Organization launched in 1999 an initiative to eliminate the global avoidable blindness and prevent the projected doubling of avoidable visual impairment between 1990 and 2020 (Vision 2020: The Right to Sight). The World Health Assembly (WHA) adopted resolutions WHA 59.25, WHA 56.26 urging member states to adopt the Vision 2020 principles. More than 90 nongovernmental development organizations, agencies, and institutions, together with a number of major corporations, are now working together in this global partnership. Two neighboring states in North Western Nigeria provide eye care services using different approaches; one state uses the principles of Vision 2020, the other uses a different strategy. The aim of the study was to assess awareness and utilization of eye care services in two Nigerian states. A population-based cross-sectional interview of households was conducted in two neighboring states using a structured questionnaire. Data analysis was performed using SPSS version 21 and a P < 0.05 was considered as significant. Participation rate was 97% in the two states. The population in the Vision 2020-compliant state were significantly more aware about general eye care services (80% vs. 44%, P < 0.0005); had less proportion of households unaware of any eye care service (55% vs. 69%, P < 0.0005); and have a significantly higher felt the need to utilize eye care services (47% vs. 5.9%, P < 0.0005). The service utilization rate was however low in the two states. The principles of Vision 2020: The Right to Sight is adaptable to different cultures/societies and has demonstrated a potential to increase awareness and a felt need for eye care in poor resource settings.

Prevalence of visual problems in a rural population of Kenya

Dear editor, The poverty that is present in low-income countries has drastic consequences for blindness, visual impairment and general eye care services. Despite containing 10% of the world’s population, Africa accounts for 19% of the global blindness with an incidence of more than 1% (Naidoo 2007). Kenya is an African country of low development, with a human development index of 0.47. In this country, we have recently conducted a massive campaign of refractive error assessment in the context of international cooperation that has allowed us to study the prevalence of refractive errors and blindness associated with this factor in large sample of population. A total of 326 people attending for eye examination in April 2011 in the area of Voi and Buguta in South Kenya were examined. Mean age was 43.0 (SD: 19.3) years, with 53.1% women. LogMAR uncorrected visual acuity (UCVA) at distance was found to range from −0.08 to 1.30, with a mean value of 0.17 (SD: 0.25). Refraction was obtained in a total of 100 eyes because of the significant limitation in UCVA (≥0.3 LogMAR). Table 1 summarizes the mean refractive outcomes obtained. The percentage of refracted eyes with myopia, defined as an SE of −0.50 D or more negative, was 58%. The percentage of refracted eyes with hyperopia defined as an SE of +0.5 D or greater was 30%, while the percentage of hyperopia defined as an SE of +2.00 D or greater was 4% (Fig. 1). Distribution of the spherical equivalent in the 100 eyes in which spherocylindrical refraction was obtained. The main pathological conditions that were detected were as follows: cataract (14 patients, 4.3%), corneal leukoma (2 patients, 0.6%), ocular trauma (6 patients, 1.9%), exotropia (1 patient, 0.3%), glaucoma (3 patients, 0.9%) and conjunctivitis (4 patients, 1.2%). Pseudophakia was present in a total of 18 patients (5.5%). The prevalence of blindness (1.3%) and visual impairment (6.3%) found (Table 2) was similar than that reported in Kibera slums of Nairobi (0.6% and 6.2%) (Ndegwa et al. 2006) as well as than that reported in the Nakuru district (2% and 5.8%, respectively) (Mathenge et al. 2007). Therefore, our results are consistent with the previous scientific evidence. The incidence of refractive error as a cause of visual impairment was higher than that caused by cataract, but percentages were smaller (21.6% and 8.1%, respectively) than those reported in the previous mentioned studies. This suggests a greater coverage of vision services in the area analysed compared to other regions evaluated previously. One factor accounting for this may be the increasing number of campaigns for the prevention of blindness carried out in rural Kenya in the recent years. In this campaign, prescription was provided in a total of 181 patients (55.5%), sunglasses in 29 patients (8.9%) and artificial tears in 12 patients (3.7%). From the total of prescription glasses provided, 137 were for the correction of presbyopia (75.69%). It should be considered that presbyopia is the most common spectacle requirement in low-income regions, and the unmet need for presbyopic spectacles in these regions is very high (Sherwin et al. 2008). In conclusion, the main cause of visual impairment is the presence of refractive error followed by cataract. Both causes are avoidable with a correct clinical management. This suggests that there is still a need of implementation of the eye care service in this region in spite of existing lower rates of visual impairment in comparison with other African countries. We thank the MATH-Kenya (Embracing the World) for their support in the campaign.

Discrimination between Glaucomatous and Nonglaucomatous Eyes Using Quantitative Imaging Devices and Subjective Optic Nerve Head Assessment

To compare the diagnostic ability of the confocal scanning laser ophthalmoscope (HRT-II; Heidelberg Engineering, Heidelberg, Germany), scanning laser polarimeter (GDx-VCC; Carl Zeiss Meditec, Inc., Dublin, CA), and optical coherence tomographer (StratusOCT, Carl Zeiss Meditec, Inc.) with subjective assessment of optic nerve head (ONH) stereophotographs in discriminating glaucomatous from nonglaucomatous eyes. Data from 79 glaucomatous and 149 normal eyes of 228 subjects were included in the analysis. Three independent graders evaluated ONH stereophotographs. Receiver operating characteristic curves were constructed for each technique and sensitivity was estimated at 80% of specificity. Comparisons of areas under these curves (aROC) and agreement (kappa) were determined between stereophoto grading and best parameter from each technique. Stereophotograph grading had the largest aROC and sensitivity (0.903, 77.22%) in comparison with the best parameter from each technique: HRT-II global cup-to-disc area ratio (0.861, 75.95%); GDx-VCC Nerve Fiber Indicator (NFI; 0.836, 68.35%); and StratusOCT retinal nerve fiber layer (RNFL) thickness (0.844, 69.62%), ONH vertical integrated rim area (VIRA; 0.854, 73.42%), and macular thickness (0.815, 67.09%). The kappa between photograph grading and imaging parameters was 0.71 for StratusOCT-VIRA, 0.57 for HRT-II cup-to-disc area ratio, 0.51 for GDX-VCC NFI, 0.33 for StratusOCT RNFL, and 0.28 for StratusOCT macular thickness. Similar diagnostic ability was found for all imaging techniques, but none demonstrated superiority to subjective assessment of the ONH. Agreement between disease classification with subjective assessment of ONH and imaging techniques was greater for techniques that evaluate ONH topography than with techniques that evaluate RNFL parameters. A combination of subjective ONH evaluation with RNFL parameters provides additive information, may have clinical impact, and deserves to be considered in the design of future studies comparing objective techniques with subjective evaluation by general eye care providers.

Prevalence of visual impairment and utilization of rehabilitation services in the visually impaired elderly population of Quebec.

Data on the prevalence of reported visual impairment and on the utilization of rehabilitation services were collected on a sample consisting of 1777 community-residing people aged at least 65 years. A visual disability was considered to be present if the answer to at least one of the following two questions was positive: Do you have trouble reading ordinary newsprint with glasses (if normally worn)? Do you have trouble clearly seeing the face of someone 12 feet away with glasses (if normally worn)? Prevalence of a reported near disability was 7.6%, prevalence of a reported distance disability was 4.4%, and 3.5% of subjects reported both types of disability. In a subsample of the surveyed population, the positive predictive value was 21% and the negative predictive value was 100%, using moderate or worse visual impairment as the gold standard. Among those answering yes to both questions, 11.4% received services from a rehabilitation center and 10.0% from a nonprofit agency. The utilization rates (adjusted to apply only to those whose visual impairment was confirmed by visual examination) reached 20% for rehabilitation centers and 17.5% for nonprofit agencies. Low utilization of rehabilitation services raises questions concerning the role of general eye care practitioners, community-based health centers, and rehabilitation centers in the rehabilitative process of the visually impaired elderly.

An anatomic index for the severity of ocular injuries.

Ocular injuries are a frequent cause of monocular blindness and cause disfigurement and discomfort. We developed a measure of severity for eye injuries using a multi-attribute utility (MAU) model. The severity index scoring was applied to eye injuries that presented at hospitals in Wisconsin, U.S.A. The resulting distribution of severities was compatible with that seen by general eye care physicians. A severity scale provides a means of comparing the severity of injuries from a wide variety of traumatic sources (e.g. automobile crashes, combat injuries, occupational accidents, etc.) and is useful in evaluating preventive and public health measurements.

Discrepancy in the Evaluation of Visual Impairment of Elderly Low-Vision Patients by General Eye Care Practitioners and by Low-Vision Practitioners

Levels of impairment and disability determine eligibility for different welfare programs for visually handicapped persons. General eye care practitioners have to determine the level of impairment for administrative purposes, whereas the low-vision practitioner measures the level of impairment in order to plan the rehabilitation program. We compared the severity of visual impairment reported by the referring practitioners and the one reported by the low-vision specialists for the population of elderly low-vision patients receiving care from one of the largest rehabilitation centers for the visually handicapped in Quebec. Visual acuity ratings reported by general practitioners are lower than those reported by low-vision practitioners. The presence of visual handicap is generally well identified but the severity of visual impairment according to the World Health Organization (WHO)'s categories is not properly gauged by the general eye care practitioners as expressed by the sensitivity and the positive predictive value of the classification of the general practitioners in respect to the classification of the low-vision optometrists. The need to use existing standardized methods to measure visual acuity (VA) is emphasized. It may be hypothesized that this overestimation of the severity of the visual condition may have a negative impact on the process of rehabilitation of the elderly.