Ophthalmic Nurses Research Articles

165 Cataract Surgery: What Intraoperative Factors Impact Surgical Outcomes in Low- and Middle- Income Countries (LMICs)

Abstract Aim To describe what intraoperative factors affect the outcomes of cataract surgery in LMICs. Method The following databases were screened to find relevant articles: EMBASE (1974–2019), MEDLINE (1946–2019), Global health (1973–2019), PubMed, Cochrane library and Cumulative Index to Nursing and Allied Health Literature. Following this, duplicates were removed, and articles underwent screening. Results Perioperative checks – It has been recommended for LMICs to implement similar surgical checklists to what is used in the UK, to reduce the chance of surgical complications. Having the right team - The cataract surgery team may vary in different countries. For example, in Ethiopia the staffing model includes ophthalmologists, non-physician cataract surgeons (NPCS), ophthalmic officers, ophthalmic nurses, operating room nurses and integrated eye care workers. It is common in LMICs for NPCS to outnumber ophthalmologists. Adequately skilled professionals – It’s important to consider having vitreoretinal surgical input available should surgical complications arise. This will help to optimise outcomes. Surgical technique – Techniques performed in LMICs include ICCE (intracapsular cataract extraction), ECCE (extracapsular cataract extraction and MSICS (manual small incision surgery) and phacoemulsification. ECCE and MSICS is the most commonly used in LMICS due to comparable outcomes with phacoemulsification and cost effectiveness. Surgical training and skills transfer – Various international training programmes such as the HelpMeSee programme is designed to help train ophthalmologists and NPCS in MSICS via simulation. Conclusions The above factors are important considerations which influence surgical availability and success. LMICs have an increasingly aging population and cataract services will be required to adapt to the increase demand.

Design and Application of Nursing Record Sheet and Operation Registration Form for Ophthalmic Daytime Operation

Objective: To explore the effect of nursing record sheet and operation registration form in daytime ophthalmic surgery. Methods: the nursing record sheet and operation registration form of daytime ophthalmic surgery were designed and used to evaluate the incidence of adverse events and the satisfaction of doctors in the operating room before and after use. Results: from January 2018 to June 2019, there were 15 adverse events caused by unclear handover, wrong record, wrong eye classification, wrong application of antibiotics and waiting for surgical consumables in ophthalmology due to nursing record, with an incidence of 3.71%;From July 2019 to December 2020, there were only 2 cases of ophthalmic defects caused by the record sheet, with an incidence of 0.42%;The difference was statistically significant(P=0.00095). When the daytime ophthalmic surgery nursing record sheet was not used from January 2018 to June 2019, the satisfaction of ophthalmic surgeons was 71%, and after using the daytime ophthalmic surgery nursing record sheet from July 2019 to December 2020, the satisfaction of ophthalmic surgeons increased to 96%. Conclusion the design of daytime ophthalmic surgery nursing record sheet is reasonable and convenient, which can effectively ensure the quality of daytime ophthalmic surgery nursing, improve work efficiency and improve job satisfaction of surgeons.

Application of Nursing Safety in Ophthalmic Nursing Management

Application of Nursing Safety in Ophthalmic Nursing Management

Development of a diabetic retinopathy screening model for a district health system in Limpopo Province, South Africa

Background: Diabetes mellitus (DM) and diabetic retinopathy (DR) are important issues in the district health system (DHS) of South Africa (SA). Guidelines for the management of DR in SA were developed more than a decade ago but not effectively implemented.Aim: The aim of this study was to develop a suitable model for DR that could be effectively implemented by a team of healthcare practitioners (HCPs) to co-manage DM and DR in the DHS of SA.Setting: The study was conducted through Voortrekker District Hospital, Limpopo Province, SA.Methods: A saturated strategy sample study was employed, and questionnaires were distributed to 24 endocrinologists in both private and public practices in Gauteng Province and to three ophthalmologists and 10 medical officers (MOs) in ophthalmology in health institutions in Waterberg and Capricorn districts of Limpopo Province. The questionnaires distributed included questions relating to the recommended roles of primary healthcare (PHC) nurses, MOs in general practice, MOs in ophthalmology, ophthalmic nurses, optometrists, and ophthalmologists to manage patients with DM in the public sector. The Delphi technique was employed requiring experts to comment qualitatively and quantitatively to elicit the required information.Results: At PHC level, PHC nurses are to document a comprehensive patient case history and assess vitals before referring to MOs in general practice. Medical officers in general practice are to assess DM control and screen for target organ disease. All patients with DM are to be referred to optometrists for retinal photography. Optometrists and ophthalmic nurses are to detect, grade and monitor pre-proliferative stages of DR, and refer to MOs in ophthalmology or ophthalmologists at district or tertiary hospitals for surgical intervention or treatment.Conclusion: Based on the expertise of the endocrinologists and ophthalmologists concerned, a DR screening model for a DHS was proposed, reflecting the role of HCPs in the management of DM and DR in the DHS of Limpopo Province, SA.

COVID-19 Pandemic: A Survey of Safety Practices among Eye Care Workers in Nigeria

Abstract Objective: To assess safety practices among eye care workers in Nigeria during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This research was a cross-sectional study. A structured electronic questionnaire was distributed among eye care workers (ophthalmologists, optometrists, ophthalmic nurses) across the six geographical zones of Nigeria. Information on socio-demographics, COVID-19 infection, current working conditions and safety practices were obtained. Data analysis was done using Statistical Package for Social Sciences (SPSS Inc. Chicago Illinois, USA) for windows, version 22. Results: A total of 236 eye care workers participated in the study; their mean (±SD) age was 37.13 (±8.141) years, 125 (53%) were females, and 145 (61.4%) worked in a tertiary care hospital. All participants described COVID-19 as a viral disease and 98.3% agreed that the disease can affect the eyes. Outpatient clinic consultation was recorded as the highest (77.7%) service provided during the pandemic. Regarding preventive practices, 95% of eye care workers wore facemasks, 82.4% wore gloves during ophthalmic examination and Hazmat suit was the least used protective device (2.5%). About three-quarters (77.5%) reported feeling unsafe in their working environment and 63.9% were dissatisfied with the personal protective device provided by hospitals to eye care workers. Conclusion: COVID-19 pandemic presented an unprecedented challenge for eye care workers; with the practice of ophthalmology posing a high risk of transmission of the virus. Efforts should be made to provide the required personal protective devices needed for optimum protection of eye care workers in healthcare settings.

Development of a diabetic retinopathy screening model for a district health system in Limpopo Province, South Africa

Background: Diabetes mellitus (DM) and diabetic retinopathy (DR) are important issues in the district health system (DHS) of South Africa (SA). Guidelines for the management of DR in SA were developed more than a decade ago but not effectively implemented. Aim: The aim of this study was to develop a suitable model for DR that could be effectively implemented by a team of healthcare practitioners (HCPs) to co-manage DM and DR in the DHS of SA. Setting: The study was conducted through Voortrekker District Hospital, Limpopo Province, SA. Methods: A saturated strategy sample study was employed, and questionnaires were distributed to 24 endocrinologists in both private and public practices in Gauteng Province and to three ophthalmologists and 10 medical officers (MOs) in ophthalmology in health institutions in Waterberg and Capricorn districts of Limpopo Province. The questionnaires distributed included questions relating to the recommended roles of primary healthcare (PHC) nurses, MOs in general practice, MOs in ophthalmology, ophthalmic nurses, optometrists, and ophthalmologists to manage patients with DM in the public sector. The Delphi technique was employed requiring experts to comment qualitatively and quantitatively to elicit the required information. Results: At PHC level, PHC nurses are to document a comprehensive patient case history and assess vitals before referring to MOs in general practice. Medical officers in general practice are to assess DM control and screen for target organ disease. All patients with DM are to be referred to optometrists for retinal photography. Optometrists and ophthalmic nurses are to detect, grade and monitor pre-proliferative stages of DR, and refer to MOs in ophthalmology or ophthalmologists at district or tertiary hospitals for surgical intervention or treatment. Conclusion: Based on the expertise of the endocrinologists and ophthalmologists concerned, a DR screening model for a DHS was proposed, reflecting the role of HCPs in the management of DM and DR in the DHS of Limpopo Province, SA.

Safety and efficacy of nurse led intravitreal injection service with Precivia® injection assist device.

Intravitreal anti-VEGF injections are the most frequently performed outpatient procedure in the UK. Ophthalmic allied healthcare professionals are replacing medical professionals in delivering injections nationwide. The use of injection assist devices such as Precivia® has been well established and increasingly adopted to aid in their safe delivery. We present outcomes of nurse-led intravitreal injections using the Precivia® injection assist device over a five-year period in the UK. A retrospective review was completed of all anti-VEGF intravitreal injections delivered at the Great Western Hospital between May 2015 and May 2020. Over the five-year study period, 2318 patients underwent a total of 26,923 intravitreal injections; 20,421 (75.8%) of which were delivered by appropriately trained ophthalmic nurses. The annual number of injections increased year-on-year from 2112 injections in 2015-2016 to 5410 injections in 2019-2020. The mean age of patients was 75.7±12.2 years with a female-to-male ratio was 1.17:1. Wet age-related macular degeneration represented the major indication for injections followed by retinal vein occlusion and diabetic maculopathy respectively. Three cases of post-injection endophthalmitis out of 20,421 (0.015%) injections in nurse injection group were identified during the study period. There were no cases of lens touch, retinal detachment or systemic thromboembolic events. Use of the Precivia® intravitreal injection assist device by trained ophthalmic allied health professionals is a safe and cost-effective way to deliver intravitreal injections service.

Training of nonophthalmologists in diabetic retinopathy screening.

The burden of diabetes mellitus (DM) and diabetic retinopathy (DR) is at alarming proportions in India and around the globe. The number of people with DM in India is estimated to increase to over 134 million by 2045. Screening and early identification of sight-threatening DR are proven ways of reducing DR-related blindness. An ideal DR screening model should include personalized awareness, targeted screening, integrated follow-up reminders, and capacity building. The DR screening technology is slowly shifting from direct examination by an ophthalmologist to remote screening using retinal photographs, including telescreening and automated grading of retinal images using artificial intelligence. The ophthalmologist-to-patient ratio is poor in India, and there is an urban–rural divide. The possibility of screening all people with diabetes by ophthalmologists alone is a remote possibility. It is prudent to use the available nonophthalmologist workforce for DR screening in tandem with the technological advances. Capacity-building efforts are based on the principle of task sharing, which allows for the training of a variety of nonophthalmologists in DR screening techniques and technology. The nonophthalmologist human resources for health include physicians, optometrists, allied ophthalmic personnel, nurses, and pharmacists, among others. A concurrent augmentation of health infrastructure, conducive health policy, improved advocacy, and increased people's participation are necessary requirements for successful DR screening. This perspective looks at the characteristics of various nonophthalmologist DR screening models and their applicability in addressing DR-related blindness in India.

Selective laser trabeculoplasty (SLT) performed by optometrists—enablers and barriers to a shift in service delivery

Background/objectivesTo explore the acceptability, training requirements, enablers and barriers of optometrist-delivered SLT.Subjects/methodsOptometrists, fellowship and consultant grade ophthalmologists, hospital managers and patients were interviewed using pre-defined topic guides. Interviews were audio-recorded, transcribed, and subjected to thematic analysis. Overarching themes were defined by the study aims and the topic guides; subthemes were derived from the interview data.ResultsSixty-six participants (three managers, eight glaucoma specialist consultant ophthalmologists, seven clinical glaucoma fellows, 12 optometrists (two of them performing SLT), two ophthalmic nurses and 34 patients) participated in the study. Overarching themes (and subthemes) were: necessity of non-medical SLT delivery, clinical practice and training, advantages, disadvantages, concerns, challenges, community delivery of SLT, patient values and other healthcare professionals that could also deliver SLT.ConclusionsCertain clinical pre-requisites, such as gonioscopy and independent prescribing rights, were perceived as necessary for undertaking SLT training. An optometrist-delivered SLT service was expected to benefit the NHS, but there was an identified need of a standardised training scheme and robust governance. Patients were accepting of an optometrist-delivered SLT service in the hospital eye service.

A study of the role and educational needs of ophthalmic specialist nurses.

To explore the current roles, responsibilities and educational needs of ophthalmic specialist nurses (OSNs) in the UK. A survey of 73 OSNs ranging from band 4 to band 8 was undertaken in May 2018. 73% of OSNs undertake more than one active role, with 59% involved in nurse-led clinics; 63% felt formal learning resources were limited, with 63% reporting training opportunities and 21% reporting time as major barriers to further training. More than 38% emphasised hands-on clinic-based teaching had a greater impact on their educational needs. Some 64% were assessed on their skills annually and 59% felt confident with their skill set. The Ophthalmic Common Clinical Competency Framework provides a curriculum and assessment tools for OSNs to use as a structure to maintain clinical skills and knowledge. Eye departments should use this as guidance to target learning needs and improve standards of care to meet the changing needs of society.

An assessment of human resource distribution for public eye health services in KwaZulu-Natal, South Africa

Background: The development of human resources for eye health (HReH), aimed at achieving a 25% reduction in visual impairment by the year 2020, was one of the VISION 2020 objectives.Aim: To assess HReH in the public sector of KwaZulu-Natal (KZN), and its effect on the accessibility of eye care in the province.Setting: All public eye facilities in KZN.Methods: A quantitative cross-sectional study using a close-ended questionnaire to assess distribution and outputs of HReH. At the end of the questionnaire, respondents gave general comments on their ability to provide services.Results: Human resource rates were 0.89 for ophthalmologists, 2.44 for cataract surgeons, 4.8 for optometrists and 4.7 for ophthalmic nurses per 1 million population. Most health facilities had some HReH working in them, albeit none had dispensing opticians. Regression analysis showed that 67.1% of variation in cataract surgery was because of the number of surgeons available. Cataract surgical rates were low with a waiting period of up to 18 months. In addition to the refractive error regression analysis of 33.7%, spectacle supply was low, with a backlog of up to 9 months in some facilities.Conclusion: Overall, HReH targets as per VISION 2020 and the National Prevention of Blindness have not been met in this region. Dispensing opticians are not employed in any of the province’s health districts. An increase in the eye health workforce is necessary to improve the eye health outcomes for people dependent on public eye facilities.

Assessment of infection prevention and control measures adopted by eye care practitioners in Ghana and South Africa against COVID-19

This study investigated the infection prevention and control measures adopted by eye care practitioners in Ghana and South Africa during the lockdown phase of the COVID-19 pandemic.A descriptive, cross-sectional study was used to investigate infection prevention and control measures by eye care practitioners in Ghana (n = 189) and South Africa (n = 92) during the extended lockdown phase (01 April-30 June 2020) by both countries, immediately following the WHO declaration of COVI9–19 as a pandemic. Participants from both countries included Ophthalmologists, Optometrists, Ophthalmic nurses, and Opticians who were invited via email and social media platforms to complete an online questionnaire. The questionnaire assessed practitioners’ general knowledge on the COVID-19, viral exposure, infection prevention and control measures adopted during eye examinations.The majority of the practitioners from Ghana 140 (74%) and 43 (47%) South Africa reported COVID-19 screening at their facilities before the commencement of eye examinations. Few practitioners 77 (41%) and 9 (10)% from Ghana and South Africa, respectively had received any form of training (seminars and workshops) in COVID-19 infection prevention and control measures. Practitioners frequently practiced hand washing - Ghana (125, 66%), South Africa (70, 76%) -, wearing of nose masks - Ghana 126 (67%), South Africa 51 (55%), alcohol-rub on equipment - Ghana 115 (61%), South Africa 45(49%) as a means of sterilizing the hand and equipment against COVID-19 during close contact examinations.The majority of practitioners from the two countries adhered to basic safety protocols despite receiving no additional training on COVID-19 infection prevention. Maintenance of universal safety precautions in eye care facilities is key to preventing nosocomial infections.

Evaluation of Meibomian Gland Dysfunction Among Ophthalmic Healthcare Workers.

PurposeTo evaluate the prevalence of meibomian gland dysfunction (MGD) among ophthalmic healthcare workers.SettingA tertiary ophthalmic center.DesignProspective, observational study.MethodsForty-four volunteer ophthalmologists and ophthalmic nurses were recruited. Information including demographics, contact lens wear, history of refractive surgery and symptom score based on Standardized Patient Evaluation of Eye Dryness (SPEED) II Questionnaire for Dry Eye Disease/Ocular Surface Disease were recorded. Lipid layer thickness (LLT), meibomian glands dropout and dilation grades, and proportion of partial blinking were evaluated using an ocular surface interferometer with dynamic meibomian imaging (LipiView, Johnson & Johnson). Based on the chance of MGD, meibomian gland dropout and dilation, selected subjects also underwent treatment with a thermal pulsation system (LipiFlow, Johnson & Johnson) in one or both eyes.ResultsEighty-eight eyes of 44 volunteers were evaluated during the study period. The mean LLT was 60.0nm. Twenty-seven (61.4%) subjects had a 90% or high chance of MGD and their mean lower lid meibomian gland dropout and dilation grades were 1.2 and 1.7, respectively. Twenty-eight eyes of 16 volunteers received treatment with the thermal pulsation system. Following treatment, the mean LLT improved from 50.3nm to 61.0nm (Wilcoxon’s signed rank test, p=0.001).ConclusionDespite being more knowledgeable to MGD and more accessible to treatment, MGD is a highly prevalent condition among ophthalmic healthcare workers, with a 61.4% prevalence among the recruited subjects. This is similar to reported prevalence in Asian populations of up to 74.5%. Targeted therapy based on dynamic meibomian imaging is effective in improving both objective and subjective measures of MGD.

Competency level assessment of healthcare practitioners in managing diabetes and diabetic eye disease in the district health system of Limpopo province, South Africa

Background: There are many gaps in the management of diabetes mellitus (DM) and diabetic eye disease in the district health system (DHS) of South Africa (SA). National guidelines recommend annual eye examinations for patients with DM.Aim: The purpose of this study was to describe the self-reported skill levels of healthcare practitioners (HCPs) to conduct eye examination procedures required for a proposed diabetic retinopathy (DR) screening model.Setting: The study was conducted in public health institutions of Waterberg district and Mankweng Hospital complex (Capricorn district) in Limpopo province, SA.Methods: A cross-sectional design using purposive sampling was conducted, and questionnaires were distributed to a total of 74 HCPs. The questionnaires distributed included questions relating to the competency levels of primary healthcare nurses (PHC nurses), optometrists, ophthalmic nurses and medical officers (MOs) regarding examination procedures in the management of patients with DM and whether they agreed with the developed DR screening model.Results: All the PHC nurses had knowledge about all the examination procedures required in the proposed DR screening model, whilst 94.1% of MOs exhibited knowledge regarding the procedures required from them. Optometrists lacked knowledge of grading DR, and ophthalmic nurses were least knowledgeable about conducting internal and external eye examinations and in detecting and grading DR.Conclusion: The proposed DR screening model did not need modification. The involvement of dieticians and more ophthalmic nurses could be beneficial to the DR screening model.

Strengthening retina eye care services in Nepal: retina eye care of Nepal project

BackgroundRetinal diseases are very difficult to treat. So, early diagnoses and preventions are very important. But, few eye doctors can treat patients with retinal diseases in Nepal. Retina Eye Care of Nepal (RECON) project was designed to strengthen retina eye care services in Nepal.MethodsRECON was implemented from May 2016 to February 2019 in Nepal. Four Master Eye Doctors (MED) received Training of Trainers (TOT) from Tokushima University, Japan. MEDs developed training materials for different cadres of ophthalmic human resources, enhanced retina eye care facilities, and conducted retina-screening camp in Nepal.ResultsTwenty ophthalmologists, 16 optometrists, 48 ophthalmic assistants and 17 ophthalmic nurses, 76 physicians and 28 health workers were trained in retina care. Eight outreach retina camps were conducted.ConclusionsThe project was a novel approach to strengthen retina services in Nepal. The aim of the project was accomplished with the ultimate benefits to the needy retina patients who otherwise were going to miss the retina services.

Barriers related to the provision of cataract surgery and care in Limpopo province, South Africa: Professional ophthalmic service providers’ perspective

BackgroundCataract has been reported to be the leading single cause of visual impairment and blindness. However, uptake of cataract services is very low in rural areas though these services are available for free. This study, therefore, sought to explore barriers related to the low uptake of these services through engaging health service providers. MethodsThis study used a qualitative design to explore barriers related to the uptake of cataract surgery and care from professional nurses’ perspective in Vhembe District of Limpopo province, South Africa. The target population comprised of 20 ophthalmic service providers. Of these 20 in Limpopo Province, 15 were general nurses involved in eye health service provision, 3 registered ophthalmic nurses and 2 registered eye specialists. Three Focus Group Discussions were held with 8, 6 and 6 participants respectively. Data was collected through the use of a digital tape recorder, transcribed and then thematically analyzed. ResultsThe majority of the respondents were aged between 56 and 60 years and females constituted 80% of the respondents. In terms of experience in working in the field of ophthalmology, most of the respondents had between 1 and 10 years of experience. Reported barriers related to the provision of cataract services by patients were: Lack of provision of comprehensive awareness programs; Failure to tailor-make cataract programs that overcome cultural myths; Unavailability of cataract services at the grass-root level; Shortage of ophthalmologist and supportive ophthalmic health professionals; and inadequate cataract facilities and resources. ConclusionThere is a need for the development of comprehensive awareness campaigns and the integration of traditional health systems and the modern system to overcome myths associated with cataracts. There is a need for investment in the ophthalmic services and ensure that the service is decentralized to health facilities in the communities so as to increase coverage. More health service providers are to be trained to ensure that they are able to provide this service at the grass-root level. This would, in turn, reduce the waiting times and ensure efficient and effective ophthalmic services.

Assessment of Knowledge, Practice and Guidelines towards the Novel COVID-19 among Eye Care Practitioners in Nigeria-A Survey-Based Study.

The aim of this study was to explore knowledge, practice of risk and guidelines of the novel corona virus disease (COVID-19) infection among the eye care practitioners and the potential associated factors. A cross-sectional self-administered online survey was distributed via emails and social media networks between 2nd and 18th May 2020 corresponding to the week of the lockdown in Nigeria to eye care practitioners (ECPs). Data for 823 respondents were analyzed. Knowledge and risk practice were categorized as binary outcome and univariate and multivariate linear regression were used to examine the associated factors. The mean score for COVID-19-related knowledge of public health guidelines was high and varied across the ECPs. Ophthalmic Nurses, Ophthalmologists and Optometrists showed higher COVID-19-related knowledge than other ECPs (p < 0.001), particularly those working in the private sector. More than 50% of ECPs stated they provided essential services during the COVID-19 lockdown via physical consultation, particularly the Ophthalmologists. Most respondents reported that the guidelines provided by their Association were useful but expressed their lack of confidence in attending to patients during and after the COVID-19 lockdown. Compared to other ECPs in Nigeria, more Ophthalmic Nurses received training in the use of Personal Protective Equipment (PPE). This survey is the first to assess knowledge, attitudes and practice in response to the COVID-19 pandemic in Nigeria. ECPs in Nigeria displayed good knowledge about COVID-19 and provided eye care services during the COVID-19 lockdown in Nigeria, despite the majority not receiving any training on the use of PPEs with concerns over attending to patients. There is need for the government to strengthen health systems by improving and extending training on standard infection prevention and control measures to ECPs for effective control of the pandemic and in the future as essential health workers.

Advanced ophthalmic nurse practitioners: the potential to improve outcomes for older people with cataracts.

An ageing population has led to a substantial increase in the prevalence of visual impairments, which can compromise lifestyle, health and general physical and psychological well-being. Age-related cataracts can have a negative effect on older people's quality of life but can be corrected by surgery. It is imperative that older people have access to cataract surgery and, given government objectives of NHS efficiency gains, advanced level nurse practitioners have the potential to increase capacity for and access to cataract surgery. This article outlines the aetiology of cataracts, developments in ophthalmic nursing and the broadened scope of practice of advanced ophthalmic nurse practitioners (AONPs). It explores how the AONP is well-placed to provide high quality care to the older person who requires cataract surgery. Professional drivers for role development are explored in relation to older people.

Red reflex examination in reproductive and child health clinics for early detection of paediatric cataract and ocular media disorders: cross-sectional diagnostic accuracy and feasibility studies from Kilimanjaro, Tanzania

Background/objectivesLate presentation of congenital cataract in the developing world has led to poor outcomes such that cataract is the leading cause of childhood blindness. Our hypothesis was that, sensitivity of red-reflex testing is greater than sensitivity of torchlight examination. We aimed to compare sensitivity of new red reflex screening tools and assess the feasibility of Arclight red reflex screening in the community.Subject/methodsWe compared the diagnostic accuracy of four different screening tools for cataract and retinoblastoma performed by ophthalmic nurses, using a clinic based enriched sample of 41 positives and 60 negatives. We then conducted a separate feasibility study, training non-specialist community nurses. Following the training, community nurses examined 2827 children <5 years with Arclight who were attending their clinics for growth monitoring and immunisation.FindingsDiagnostic accuracy study: estimated sensitivities were 97.6% for Catcam, 92.7% for Arclight, 90.2% for PEEK retina and 7.3% for torchlight. Estimated specificities were above 90% for Catcam, Arclight and torchlight and 87% for PEEK retina. Feasibility study: twenty-four out of 2728 children screened failed community screening, seven were true positive (six cataract, one retinoblastoma). Prevalence of bilateral cataract was 1.5/1000 (95% CI: 0.40–3.75 per 1000).ConclusionsArclight and CatCam have higher sensitivity than torchlight, are easy to learn and use by primary health care nurses. Red reflex testing should be recommended in the WHO guidelines instead of torchlight examination to help early detection of potential blinding causes including congenital cataract and retinoblastoma.

What is the best way to measure intraocular pressure (IOP) in a virtual clinic?

Patients with ocular hypertension (OHT) and glaucoma are increasingly reviewed in virtual clinics. As the clinician is not present during the patient's visit it is important that measurements obtained are reliable. The aim of this study was to examine agreement between Goldmann Applanation Tonometry (GAT) intraocular pressure (IOP) measurements (obtained by ophthalmologists and ophthalmic nurses) and a newer automated tonometer-the Ocular Response Analyzer (ORA). A prospective study was conducted including 116 eyes of 116 patients with glaucoma and OHT. All subjects had GAT IOP obtained by a nurse and ophthalmologist and ORA IOP by a technician. The order of testing was randomised and previous measurements were masked. Agreement was examined using Bland-Altman plots and 95% limits of agreement (LoA). Intraclass correlation coefficients (ICC) of repeat GAT and ORA measurements were calculated. Patients had a mean age of 70 ± 13 years. The 95% LoA between ophthalmologist (mean: 14.6 ± 4.3 mmHg) and nurse (mean: 15.0 ± 4.0 mmHg) GAT measurements was ±5.21 mmHg, whereas the 95% LoA between repeat ORA IOPg (mean: 13.8 ± 4.7 mmHg) was ±2.52 mmHg. There was no proportional bias. The ICC was 0.972 for repeat IOPg compared with 0.863 for repeat GAT. There was only moderate agreement between GAT IOP measurements obtained by nurses working in the virtual clinic and ophthalmologists. Agreement between ORA IOP and ophthalmologists' GAT IOP was better and ORA produced more repeatable measurements, providing evidence it may be a more reliable tool for IOP assessment in virtual clinics.