Ophthalmic Professionals Research Articles

Using Smartphones to Enhance Vision Screening in Rural Areas: Pilot Study.

While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge. We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited. A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel. A total of 5 of 73 (6.8%, 95% CI 2.3%-15.3%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72-prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria). The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas.

NORMAL TENSION GLAUCOMA IN A PREGNANT FEMALE : CASE REPORT

Normal tension glaucoma (NTG) is a disease associated with normal intraocular pressure(IOP) (10 mmHg – 21 mmHg) that may lead to irreversible blindness if misdiagnosed or left untreated over a period of time. The author observed a patient with NTG diagnosed for rst time in her third trimester of pregnancy. The initial visual eld analysis results showed visual eld defects with normal IOP. Although the patient was known case of Hypertension, a condition associated with optic nerve head damage, the patient's visual eld defects were found to have progressed by the end of pregnancy. It is therefore important for ophthalmic professionals to apply due diligence when examining patients with NTG in order to expedite intervention and prevention of visual impairment and blindness.

Navigating the Unseen City: Town Planners, Architects, Ophthalmic Professionals, and Charity Opinions on Navigating of the Built Environment with a Visual Impairment.

People with a visual impairment often find navigating around towns and cities difficult. Streetscape features such as bollards, street cafés, and parked cars on pavements are some of the most common issues. in this paper semi-structured interviews were conducted with stakeholders including built environment professionals, visually impaired individuals, ophthalmic professionals, and sight loss charities. All stakeholders felt there were barriers and enablers to navigating streets with a visual impairment. Stakeholders agreed these can have an impact on the daily lives of those with a visual impairment. While built environment professionals knew of policies and guidance around accessibility for people with a visual impairment, there was a lack of professional knowledge about the spectrum of visual impairment. Despite this, stakeholders felt these small changes could have a positive impact, making accessible cities for all. A collaborative approach to streetscape design and further education could help create better environments for all.

Metamorphosis of Contact Lenses

In 1971, soft contact lenses were a striking addition to the ophthalmic field that related functionally to the existing hard contact lenses by correctingrefractive error, but their properties and description were different so as to confound ophthalmic professionals in their introduction. Their inventor Otto Wichterle, a Czechoslovakian chemist and anticommunist dissident, developed the soft lens in the 1950-60s with little knowledge of the hard lens, but its potential was broad enough to break through the communist barriers and to spark international consumer interest and development.Challenges in manufacturing and developing soft contact lenses created a complex discipline around the cornea and lid physiology, and optics. This expanded greatly the scientific knowledge of the eye and adnexa to allow a soft, hydrophilic lens to remain symbiotic with the eye. Challenges were met over the past 50 years with a change in nomenclature and in automated manufacturing closer to hard lenses, optical advancements, new materials and surface treatments, and lens disinfection methods. The science developing from the diminutive soft lens led to the incorporation of related biomedical and polymer science within the broader ophthalmic field that inordinately influenced optical advancements, instrumentation,and ocular pathology.

Acceptance of a Smartphone-Based Visual Field Screening Platform for Glaucoma: Pre-Post Study.

BackgroundGlaucoma, the silent thief of sight, is a major cause of blindness worldwide. It is a burden for people in low-income countries, specifically countries where glaucoma-induced blindness accounts for 15% of the total incidence of blindness. More than half the people living with glaucoma in low-income countries are unaware of the disease until it progresses to an advanced stage, resulting in permanent visual impairment.ObjectiveThis study aims to evaluate the acceptability of the Glaucoma Easy Screener (GES), a low-cost and portable visual field screening platform comprising a smartphone, a stereoscopic virtual reality headset, and a gaming joystick.MethodsA mixed methods study that included 24 eye care professionals from 4 hospitals in Southwest Ethiopia was conducted to evaluate the acceptability of GES. A pre-post design was used to collect perspectives before and after using the GES by using questionnaires and semistructured interviews. A Wilcoxon signed-rank test was used to determine the significance of any change in the scores of the questionnaire items (two-tailed, 95% CI; α=.05). The questionnaire and interview questions were guided by the Unified Theory of Acceptance and Use of Technology.ResultsPositive results were obtained both before and after use, suggesting the acceptance of mobile health solutions for conducting glaucoma screening by using a low-cost headset with a smartphone and a game controller. There was a significant increase (two-tailed, 95% CI; α=.05) in the average scores of 86% (19/22) of postuse questionnaire items compared with those of preuse questionnaire items. Ophthalmic professionals perceived GES as easy to use and as a tool that enabled the conduct of glaucoma screening tests, especially during outreach to rural areas. However, positive evaluations are contingent on the accuracy of the tool. Moreover, ophthalmologists voiced the need to limit the tool to screening only (ie, not for making diagnoses).ConclusionsThis study supports the feasibility of using a mobile device in combination with a low-cost virtual reality headset and classic controller for glaucoma screening in rural areas. GES has the potential to reduce the burden of irreversible blindness caused by glaucoma. However, further assessment of its sensitivity and specificity is required.

Knowledge and awareness-based survey of COVID-19 within the eye care profession in Nepal: Misinformation is hiding the truth.

Nepal was under a severe lockdown for several months in 2020 due to the COVID-19 pandemic. There were concerns regarding misinformation circulating on social media. This study aimed to analyse the knowledge and awareness of COVID-19 amongst eye care professionals in Nepal during the first wave of the pandemic. We invited 600 participants from 12 ophthalmic centres across Nepal to complete a qualitative, anonymous online survey. Altogether, 25 questions (both open and closed-ended) were used. An overall performance score was calculated from the average of the 12 "Knowledge" questions for all the participants. Of the 600 eye care professionals invited, 310 (51%) participated in the survey. The symptoms of COVID-19 were known to 94%, whilst only 49% of the participants were aware how the disease was transmitted, with 54% aware that anyone can be infected with SARS-CoV-2. Almost 98% of participants recognized the World Health Organization's (WHO) awareness message, but surprisingly, 41% of participants felt that consumption of hot drinks helps to destroy the virus, in contradiction to WHO information. Importantly, 95% of the participants were aware of personal protective equipment (PPE) and what the acronym stands for. Social distancing was felt to be key to limiting the disease spread; whilst 41% disagreed that PPE should be mandatory for eye care practitioners. The mean overall "Knowledge" performance score was 69.65% (SD ± 22.81). There is still considerable scope to improve the knowledge of COVID-19 amongst ophthalmic professionals in Nepal. Opinion is also split on measures to prevent transmission, with misinformation potentially fuelling confusion. It is recommended to follow WHO and national guidelines, whilst seeking published scientific evidence behind any unofficial statements, to accurately inform one's clinical practice.

Attitudes, experiences, and preferences of ophthalmic professionals regarding routine use of patient-reported outcome measures in clinical practice.

Background/ObjectivesRoutine use of patient-reported outcome measures (PROMs) to assess quality of health care systems is mandated in many countries and has been implemented successfully in many specialities. Ophthalmology currently lags behind. To support and inform future implementation, we investigated paediatric ophthalmic clinicians’ experience of, and future training needs for, using child-appropriate vision PROMs and their views about the barriers and enablers to future routine implementation in clinical practice.MethodsWe conducted a pilot study, using an online survey to elicit the experience, attitudes, training needs and perceptions of barriers and enablers to routine PROMs use of ophthalmic health professionals in the Paediatric Ophthalmology Department at Great Ormond Street Hospital, London. A focus-group was undertaken to discuss survey results and preferences regarding presentation of PROM data. Analysis comprised descriptive statistics, presented alongside complementary qualitative data.ResultsEighteen clinicians in the department completed the survey. Twenty-seven took part in the focus group. Clinicians had limited experience of using PROMs but high confidence in the potential positive impact on communication with patients, monitoring chronic conditions and clinical decision-making. Clinicians identified operational issues (collection and analysis of data) and impact (interpretation and application of data) as the two key areas for consideration. Training and information requirements before implementation were clearly articulated, alongside the benefits of using digital/electronic data capture ahead of consultations to allow efficiency and automated analysis, and presentation in an appropriate visual format alongside clinical data to ensure meaningful use.ConclusionThe findings of this pilot study of ophthalmic clinicians working in a specialist paediatric ophthalmology department, suggest that ophthalmic clinicians recognise the potential benefits of routine PROMs use in clinical practice. Together with existing literature outside ophthalmology relating to overcoming barriers and exploiting enablers to routine implementation, findings may be applicable in planning routine PROM implementation in paediatric ophthalmology.

Management and Treatment Modalities in Traumatic Brain Injury

ABSTRACT Traumatic Brain Injury (TBI) is a very broad diagnosis. Some TBI patients have minimal complaints for a short period of time. Other TBI patients suffer from drastic life-altering, permanent brain damage. One particularly troubling class of TBI patients arises from people who experience one or more concussions in their youth. Later, as adults, the TBI manifests as multiple learning difficulties or even personality changes. As ophthalmic professionals, we are often the first to see potential TBI patients as they complain of visual disturbances. It is of utmost importance to find ways to help these people, but first we have to find the deficits. This paper will discuss some therapeutic measures given to TBI patients and the examinations that will provide vital information.

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.

COVID-19: Limiting the Risks for Eye Care Professionals

ABSTRACT After the outbreak of the disease COVID-19, it has reached pandemic proportions within a very short time. It is mainly transmitted human-to-human through direct contact with secretions from an infected person or through inhalation of droplets containing SARS-CoV-2. It is controversial whether the virus may be transmitted via tears. Exposed ocular surface can serve as a gateway in transmission and acquiring respiratory diseases. Considering the reported cases on healthcare workers indicating nosocomial transmission and the anatomical and physiological aspects it is perceived that ophthalmic healthcare professionals are at higher risk of contracting the virus by virtue of their job. In this narrative review we discuss current evidence around detection of SARS-CoV-2 in human tears and forms of transmissions reported to date. We also provide a comprehensive approach that may be implemented in an ophthalmic care facility to protect healthcare personnel, as well as patients, from contracting the virus.

Punctal granuloma as a manifestation of intracanalicular plug‐related canaliculitis

Dry eye is a common cause of clinical visits to ophthalmic professionals and has a negative impact on quality of life.2014 In addition to topical therapy, such as lubricants and immunomodulators, i...

Novel coronavirus disease pandemic and ophthalmologist's perspectives.

Ophthalmologists are among those healers facing a higher risk of acquiring novel coronavirus disease 2019, called COVID-19, during their professional duties since they have close physical contact with their patients. Some patients with COVID-19 may present with or may develop conjunctivitis during the course of the illness. The ocular secretions and tears have been identified to have positive results to COVID-19 tests and as such could be a source of spread. This review aims at providing the useful guidelines to ophthalmic professionals for their own safety, and safety of their patients based on the available current literature, and also based on personal experience and observations. Literature search was made on PubMed for COVID-19 in relation to ophthalmology in the limited period of the last quarter of 2019 and first quarter of 2020. Research also included access to current guidelines published by various ophthalmic societies. Accordingly, present and future ophthalmic practice patterns need to be modified.

Modeling manpower requirement for a changing population health needs: The case of ophthalmic nurses and allied health ophthalmic professionals

BackgroundPrevalence of chronic eye conditions has been shown to increase with age. As the global population continues to age rapidly, the demand for eye care services is expected to increase significantly in the near future, requiring effective health workforce planning in order to provide for the needs of the population. The aim of this paper is to synthesize data from a variety of sources to develop a simulation model based on the systems modelling methodology of system dynamics that links population health needs to workforce requirements to generate evidence-based projections for ophthalmic nurses, and allied health ophthalmic professionals in Singapore. MethodsA system dynamics simulation model was developed with active engagement of key stakeholders—such as ophthalmologists, senior nurses, healthcare planners and managers, and senior technicians—to verify the model structure and assumptions. The model project the future requirement of ophthalmic nurses, technicians and patient service assistants. ResultsThe number of Singaporeans with eye diseases is projected to more than double by 2040. As a result, the demand for eye care services and eye care workforce is expected to increase significantly under all the plausible scenarios. The increase in eye disease burden is due mainly to population aging—given that the prevalence of eye disease increases with age. ConclusionThis research provides a future demand outlook for ophthalmic nurses, technicians and patient service assistants in Singapore and has implications for recruitment and training of ophthalmic nurses and allied health professionals in Singapore.

Jack J Kanski

There can be very few ophthalmologists and other ophthalmic professionals across the globe who at one time or another will not have delved into a book by Jack Kanski. Anybody...

Limbal ischemia: Reliability of clinical assessment and implications in the management of ocular burns.

Purpose:Limbal ischemia is an important prognostic factor in the management of ocular burns. In this study, we evaluated the reliability of clinically assessing limbal ischemia among ophthalmic professionals.Methods:This study included 111 ophthalmic professionals who were shown 12 diffuse illumination color slit-lamp photographs of eyes with recent chemical injuries. Respondents were asked whether the photos were assessable and if yes, then to indicate the presence, location, and grade of limbal ischemia in each case. The responses were collected using a standard data collection sheet and the inter-observer agreement was calculated.Results:All participants responded to every question. Of the 1,332 responses, images were deemed assessable in 1,222 (91.7%) instances. The overall agreement (Fleiss’ kappa) for the presence of limbal ischemia and severity of limbal ischemia was 0.106 and 0.139, respectively (P < 0.012). Among the four groups of observers, practicing cornea specialists displayed significantly (P < 0.003) higher kappa values (0.201–0.203) when compared to residents (0.131–0.185), fellows (0.086–0.127), and optometrists (0.077–0.102). All indicated a poor level of inter-rater consistency.Conclusion:The results indicate that clinical assessment of limbal ischemia is highly subjective and there is lack of reliability even among cornea specialists who regularly manage patients with ocular burns. A non-invasive, standardized, objective, accurate, and reliable modality for ocular surface angiography is desperately needed for proper assessment and prognostication of ocular burns.

Usage of glaucoma-specific patient-reported outcome measures (PROMs) in the Singapore context: a qualitative scoping exercise

BackgroundDespite the increasing emphasis on the role of glaucoma-specific patient-reported outcome measures (PROMs) as relevant outcome measures for the impact of glaucoma and its intervention on patients' daily lives, the feasibility of implementing PROMs in the routine clinical setting in Singapore remains undefined. We aim to evaluate the comprehensibility, acceptability, and relevance of four glaucoma-specific PROMs at healthcare professionals' and patients' level in a Singapore context.MethodsSixteen ophthalmic healthcare professionals and 24 glaucoma patients, with average age 60 years (SD = 15), were invited from a tertiary hospital in Singapore. Semi-structured interviews were conducted to explore participants’ perceptions on the content and administration of four glaucoma-specific PROMs - the Glaucoma Quality of Life-15, Glaucoma Symptom Identifier, Independent Mobility Questionnaire and Treatment Satisfaction Survey of Intra-ocular Pressure. Semi-structured interviews were hand transcribed, and analysed thematically. Each participant filled out a feasibility survey at the end of interview.Results79% of glaucoma patients and 94% of glaucoma healthcare professionals felt selected PROMs relevant to patients. 63% of glaucoma patients and 50% of healthcare professionals felt that selected PROMs were sufficiently comprehensive for clinical use. 46% of glaucoma patients and 56% of healthcare professionals felt selected PROMs were user-friendly.ConclusionsUsing PROMs in the Singapore clinical setting receives promising support from both healthcare professionals and patients. The identified potential barriers tailored to Singapore clinical setting will help successful implementation of PROMs into routine clinical care.

Ophthalmic community perception of new medication needs

To survey ophthalmologists (who have participated previously in clinical research) and ophthalmic industry professionals (who have been involved in ocular research and development) to indicate perceived needs for new pharmaceuticals in various ophthalmic subspecialties. A prospective, industry-based survey was sent to ophthalmologists and ophthalmic industry professionals about the perceived needs for new pharmaceutical products. This survey was sent to 559 ophthalmic pharma professionals and ophthalmologists. We received 82 (15%) responses. The results showed that the most commonly perceived need for new pharmaceuticals were dry and wet age-related macular degeneration, glaucoma, diabetic macular edema and dry eye. There was a statistical difference found between response groups (P<0.0001). Respondents indicated they would express their commitment to a new product they perceived as needed by recommending to colleagues (63%), prescribing (60%), participating as principle investigator in a related clinical trial (52%), advising the company (52%), lecturing on behalf of the product (43%), investing in the product (38%), taking no action (7%) or obtain a position in the company (1%). Ophthalmic pharma professionals and ophthalmologists perceive the greatest need for new medicines in ophthalmology to be in dry and wet age-related macular degeneration, glaucoma, diabetic macular edema and dry eye.

Active screening and early intervention of diabetic retinopathy in community service

In China, the number of diabetic retinopathy (DR) patients is increasing rapidly. Prevention is the most effective method to reduce blindness and visual impairment caused by DR. The ophthalmic professionals who are interested in the DR prevention and treatment should promptly go to the communities, work together with general practitioners and community health personnel, make full use of community residents health archives, and gradually establish community DR screening protocols. Thus the efficiency of screening and early intervention of DR will be improved, and finally the high incidence and high prevalence of blindness related to DR will be controlled. (Chin J Ophthalmol, 2016, 52: 801-804).

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A six-step approach to curriculum development for mid-level ophthalmic professionals in Singapore

Background/Aims: Ageing populations with increasing eye care needs and a global shortage of ophthalmologists has resulted in a growing need for mid-level ophthalmic professionals. This article describes the process used to develop accredited, internationally recognised educational programmes for ophthalmic assistants, ophthalmic technicians and ophthalmic enrolled nurses in Singapore. Method: Using action research methodology, a six-step approach to curriculum development based on Hilda Taba's (1962) Curriculum Development was utilised. Results: Programmes for ophthalmic assistants and technicians were developed and piloted and through accreditation by the Joint Commission of Allied Health Professionals in Ophthalmology, the Singapore National Eye centre was granted global accreditation for these training programmes. Discussion: To cope with the greater eye care demands of the future, task-shifting from ophthalmologists to mid-level ophthalmic professionals could be a valuable approach. Education must be standardised and meet international benchmarks. Conclusions: Training mid-level ophthalmic professionals could improve access to eye care services and decrease the burden on medical staff, allowing ophthalmologists to concentrate on complex cases. Additionally, the initiation of more holistic care by mid-level ophthalmic professionals may improve patient outcomes.