Ophthalmic Services Research Articles

A community-based cross-sectional study of eye care service utilization among the adult population in southern Ethiopia.

Visual impairment, which is related to many eye diseases, is a major public health problem. If detected and treated early, it can be prevented; therefore, regular use of vision services is very important. This study aimed to assess the proportion of utilization of eye care services and associated factors among the rural community population in southern Ethiopia. A community-based cross-sectional study design with a two-stage cluster random sampling technique was conducted to collect data from adults aged 40 years and above using interviewer-administered questionnaires. Kebeles were randomly selected by the lottery method, and systematic random sampling with proportional distribution was used to select the households. An adult individual was randomly selected from a household when there was more than one adult available. A binary logistic regression model was used to establish the association between eye care service utilization and the variables that might affect it. Of the 551 study population, 510 responded to this study, and the response rate was 92.6%. The mean age of the respondents was 52.2 years. The rate of eye care service utilization was 29% (95% confidence interval (0.25, 0.33)). The study shows that older participants, aged 65 and above (adjusted odds ratio: 4.04; 95% confidence interval (2.20, 7.43)), having previous eye problems (adjusted odds ratio: 10.04; 95% confidence interval (5.81, 17.33)), the presence of systemic illness (adjusted odds ratio: 2.52; 95% confidence interval (1.21, 5.21)), and having awareness about regular checkups (adjusted odds ratio: 11.75; 95% confidence interval (6.62, 20.84)) were found to be the predictors of eye care service utilization. In this study, utilization of eye care services was low. Older age, previous eye problems, systemic illness, and awareness about checkups were found to be predictors of eye care service utilization. Hence, there is a need to increase the absorption of existing ophthalmic services and create awareness of the use of ophthalmology services to reduce preventive blindness.

Regulatory and legal ensuring the ophthalmic services and assistance provision in Ukraine

Regulatory and legal ensuring the ophthalmic services and assistance provision in Ukraine

Home-Use Sleep Mask (Noctura 400) Wear Before and During The COVID-19 Pandemic with its Associated Lockdowns in England

Objective: The Researchers looked to determine over a 2-year period whether patients with early diabetic macular oedema (DMO) would wear a mask (Noctura 400) during sleep and maintain a good level of use throughout the study period, with regular follow ups to monitor and discuss use. As the COVID-19 pandemic began during this study, the researchers also had the opportunity to evaluate mask use during lockdown periods in England and while there was massive disruption to hospital ophthalmic services. Methods: A total of 26 patients were recruited for the study and, for each one, regular phone and text support was put in place to help with Noctura 400 wear. In the first year, regular 3 monthly hospital visits were provided whereas in the second year the visits mostly did not take place due to COVID-19 restrictions, though phone calls and texts continued for the entire duration. Results: In a questionnaire at the end of year 1, the vast majority of the patients found the sleep mask comfortable and easy to use. A total of 21 out of 26 completed the whole 2 years of home treatment and none of those who dropped out did so for light mask related reasons. The researchers found with the appropriate level of support and encouragement that a high level of mask wear compliance was achieved (76.1% for the 2 years). The initial compliance was 80.1% that dropped slightly to 76.6% at year-end but was maintained throughout the second year with a final median compliance of 75.1%. Compliance dropped slightly (but not significantly) during the ongoing pandemic that included 3 lockdowns in England and disruption of hospital services such that in the second year 18 of the 21 (85.7%) completing patients had no hospital visits. Conclusion: The Noctura 400 sleep mask was worn effectively for a protracted period of time by the group of patients when appropriately supported even when there was severe hospital service disruption. The need for effective home treatments during these unpredictable times is highlighted.

ASSESSMENT OF THE READINESS OF A MULTIPROFESSIONAL HEALTH CARE FACILITY FOR THE IMPLEMENTATION OF NEW ORGANIZATIONAL FORMALS OF OPHTHALMOLOGY ASSISTANCE TO THE ADULT POPULATION

Introduction. We considered the main aspects of the organization of providing ophthalmic care to the adult population in Ukraine, analyzed the problems and described our own experience in implementing innovative technologies for improving the prevention, diagnosis, and surgical treatment of eye diseases.
 Aim. Conducting an analysis of the market for the provision of medical services to patients with diseases of the visual organs to determine the ability of a health care institution to provide a full cycle of diagnostics and surgical treatment in the conditions of one institution.
 Materials and methods. Bibliosemantic and statistical methods, a SWOT analysis was conducted to determine the effectiveness of management
 Results and their discussion.
 Based on the results of the marketing analysis, it was established the possibility of organizing and providing comprehensive timely high-tech microsurgical treatment of ophthalmic diseases in patients using modern equipment on the basis of SIS RPCPCM SADS and, importantly, by one doctor. This makes it possible not only to improve the quality of ophthalmic services, but also to increase the scope of their provision, shorten the patient's route and increase access to timely high-tech microsurgical treatment of ophthalmic diseases.
 Conclusions. Thus, the presented organizational structure and the implementation of a full cycle of providing high-tech ophthalmic care to adult patients will ensure a constant improvement in the quality of providing medical care to the population and, to a certain extent, reduce the costs of providing it.

Barriers and enablers for technology diffusion in ophthalmology at not-for-profit advanced eye care institute

Managed care and insurance have penetrated ophthalmic services for patient care and continue to affect outof-pocket spending related to eye care. In such a scenario, understanding technology diffusion is crucial from the perspective of both technology developers as well care providers. Should healthcare organizations choose cheaper technologies or the ones that can be quickly diffused? In this paper, we try to answer this question by reviewing technologies used in the past 10 years across different services in ophthalmology. We generate a framework that bifurcates technologies and provides nomenclature to them based on cost and speed of diffusion. Our work, within its limitations, can provide insights into contemporary technology producers and healthcare organizations.

State-sponsored price transparency programs for ophthalmic services

ObjectivesTo characterize the information provided by state-sponsored price transparency programs and describe price variation for ophthalmic services. MethodsWe searched for state-sponsored price transparency programs and reviewed all available information on ophthalmic services. ResultsIn total, 55% (6/11) of state-sponsored price transparency programs included ophthalmic services. Three provided nonfinancial value metrics, five provided prices by clinician organization, and none reported out-of-pocket costs, insurance costs, or prices by insurers for ophthalmic services. The median within-state price ratio was 3.65 (interquartile ratio [IQR]: 2.04–7.91). Mean prices for cataract surgery ranged from $2575 to $5097 and from $873 and $27,801.66 for retinal detachment repair. DiscussionMost of the eleven state-sponsored price transparency programs included pricing information for ophthalmic services. No programs provided specific out-of-pocket costs, insurance costs, or prices by insurers for ophthalmic services. There was substantial variation in prices for all included ophthalmic services within and between states.

The Importance of Health Literacy in Addressing Eye Health and Eye Care Disparities

Disparities in eye health and eye care frequently result from a lack of understanding of ocular diseases and limited use of ophthalmic health services by various populations. The purpose of this article is to describe the principle of health literacy and its central role in enhancing health, and how its absence can result in poorer health outcomes. The article evaluates the current status of health literacy in visual health and disparities that exist among populations. It also explores ways to improve health literacy as a means of reducing disparities in visual health and eye care. Advancing dissemination of health information and enhancing health literacy may help not only to reduce healthcare barriers in the underserved populations but also to lessen visual health disparities.

Regional variations and temporal trends of childhood myopia prevalence in Africa: A systematic review and meta-analysis.

To provide contemporary and future estimates of childhood myopia prevalence in Africa. A systematic online literature search was conducted for articles on childhood (≤18 years) myopia (spherical equivalent [SE] ≤ -0.50D; high myopia: SE ≤ -6.00D) in Africa. Population- or school-based cross-sectional studies published from 1 Jan 2000 to 30 May 2021 were included. Meta-analysis using Freeman-Tukey double arcsine transformation was performed to estimate the prevalence of childhood myopia and high myopia. Myopia prevalence from subgroup analyses for age groups and settings were used as baseline for generating a prediction model using linear regression. Forty-two studies from 19 (of 54) African countries were included in the meta-analysis (N=737,859). Overall prevalence of childhood myopia and high myopia were 4.7% (95% CI: 3.3%-6.5%) and 0.6% (95% CI: 0.2%-1.1%), respectively. Estimated prevalence across the African regions was highest in the North (6.8% [95% CI: 4.0%-10.2%]), followed by Southern (6.3% [95% CI: 3.9%-9.1%]), East (4.7% [95% CI: 3.1%-6.7%]) and West (3.5% [95% CI: 1.9%-6.3%]) Africa. Prevalence from 2011 to 2021 was approximately double that from 2000 to 2010 for all studies combined, and between 1.5 and 2.5 times higher for ages 5-11 and 12-18 years, for boys and girls and for urban and rural settings, separately. Childhood myopia prevalence is projected to increase in urban settings and older children to 11.1% and 10.8% by 2030, 14.4% and 14.1% by 2040 and 17.7% and 17.4% by 2050, respectively; marginally higher than projected in the overall population (16.4% by 2050). Childhood myopia prevalence has approximately doubled since 2010, with a further threefold increase predicted by 2050. Given this trajectory and the specific public health challenges in Africa, it is imperative to implement basic myopia prevention programmes, enhance spectacle coverage and ophthalmic services and generate more data to understand the changing myopia epidemiology to mitigate the expanding risk of the African population.

Evaluation of conjunctival graft procedures and factors that lead to graft complications in canine cases.

To describe the complications of conjunctival graft surgery occurring in cases at a referral ophthalmic service and evaluate factors that lead to occurrence of complications in canine cases. A retrospective case-control study was completed using data from the Veterinary Medical Center at the Western College of Veterinary Medicine, Saskatoon, Canada, between May 2015 and March 2020. Case records from dogs that underwent conjunctival pedicle graft surgery and subsequently either did or did not develop a conjunctival graft complication were reviewed. One hundred and six dogs undergoing conjunctival graft surgeries were identified. Sixteen conjunctival graft complications occurred, of which, eight led to negative outcomes. Univariable analysis comparing canine eyes that developed complications to control eyes revealed potential (p ≤ .05) differences between the groups in post-operative fluoroquinolone use, Streptococcus canis isolation, intraoperative intravenous cefazolin use, corneal stromal white cell infiltrate, and mean ulcer diameter. The use of intraoperative cefazolin could not be effectively evaluated with available data; however, no dogs (n=22) receiving intraoperative cefazolin developed complications. Multivariable analysis revealed that dogs that were treated with a second-generation fluoroquinolone and that had S.canis isolated had higher odds of experiencing complications than dogs that were not treated with a second-generation fluoroquinolone and that were S.canis negative (Odds ratio=64.7 [95% CI 6.3-669], p < .0001). Streptococcus species played a role in conjunctival graft complications in our study. Empiric selection of second-generation fluoroquinolone monotherapy may need reconsideration given the frequent isolation of Streptococcus spp. from canine ulcers. The use of intraoperative cefazolin may be associated with a lower complication rate.

The prevalence of diabetic retinopathy in the occupied Palestinian territories: a national cross-sectional study

BackgroundDiabetic retinopathy is a complication of diabetes that affects the eyes and can lead to blindness if not adequately managed. No national or population-based estimates of diabetic retinopathy in Palestine exist. High-quality ophthalmic services are not available at the primary health care level for patients with diabetes in all sectors. Specialised eye centres are lacking. St John of Jerusalem Eye Hospital Group, which consists of five facilities in the West Bank and Gaza Strip, is the only provider of expert eye care in Palestine. The aim of this study was to determine the population prevalence of diabetic retinopathy among people with diabetes aged 50 years and older in Palestine. MethodsThis survey was part of a larger population-based survey using the rapid assessment of avoidable blindness (RAAB) methodology to estimate prevalence of vision impairment, blindness, and disability in individuals aged 50 years and older in Palestine. It was a nationally representative, cross-sectional, population-based survey in Gaza Strip and West Bank. Based on an expected prevalence of blindness of 3·4% in individuals aged 50 years and older, 20% precision level, 95% confidence level, 10% non-response rate, and a design effect of 1·4 to account for clustering, a sample size of 4224 participants aged 50 years and older was determined. 69 clusters in the West Bank and 52 clusters in the Gaza Strip were selected with probability proportionate to size from a list of areas from the Palestinian Central Bureau of Statistics population and housing census of 2017. Within each cluster, 35 people aged 50 years or older were randomly selected for examination in their homes. Three teams collected data; each consisted of a nurse and an ophthalmologist. Dilated fundus examination and Scottish diabetic retinopathy grading were done by the ophthalmologist in each team. Participants were classified as having diabetes if they had been diagnosed by a health professional, or if their random blood glucose (RBG) was 200 mg/dL or above on the day of data collection, as measured by a portable glucometer. Ethical approval was obtained from the St John of Jerusalem Eye Hospital Group and the London School of Hygiene & Tropical Medicine ethics committees. Informed oral witnessed consent was obtained from all participants. FindingsThe survey was conducted between July, 2018, and April, 2019. 4224 individuals were asked to participate, of whom 376 did not, leaving 3848 participants. The number of previously diagnosed and newly diagnosed patients with diabetes was 1176 (486 male, 690 female) and 103 (55 male, 48 female), respectively. The overall prevalence of diabetes across West Bank and Gaza was 33·2% (95% CI 31·5–34·9; 1279 of 3848 participants). The prevalence was higher in women (738 of 2047 [36·1%, 95% CI 33·6–38·5]) than in men (541 of 1801 [30·0%, 27·9–32·2), and in Gaza Strip (639 [35·8%] of 1783) than in West Bank (640 [31·0%] of 2065; p=0·002). Only 539 (46·3%) of 1164 patients with diagnosed diabetes who consented to blood blucose measurement had controlled blood glucose (RBG <200 mg/dL). 483 (41·1%) of 1176 patients with previously diagnosed diabetes had never had an eye check-up or had not been checked in the 2 years before the survey. 327 (25·6%) of 1279 patients with diabetes refused dilated fundus examination; 952 patients did undergo this examination, and 457 (48·0%, 95% CI 43·5–52·6) had diabetic retinopathy or maculopathy. Vision impairment was more common in those with diabetes (428 [33·5%] of 1279) than in those without (652 [25·4%] of 2569). 43 (3·4%) of 1279 participants with diabetes had blindness, compared with 65 (2·5%) of 2569 patients without diabetes. The principal cause of blindness in Gaza Strip was diabetic retinopathy (23 [32·4%] of 71) and in West Bank was untreated cataract (19 [51·4%] of 37). Diabetic retinopathy was the main cause of blindness, severe visual impairment, and moderate visual impairment among patients with diabetes. InterpretationDiabetes and diabetic retinopathy are substantial health problems in Palestine. Earlier detection and proper management at primary health care clinics and by outreach clinics for marginalised populations could be key. Referral networks between health-care sectors and specialised eye centres might provide the necessary infrastructure. FundingFred Hollows Foundation, Australia, German Federal Ministry for Economic Cooperation and Development.

Visually significant cataract and associated factors among older people attending a community ophthalmic service in central Gondar Zone, Northwest Ethiopia: a cross-sectional study.

ObjectiveIn this study, we aimed to determine the prevalence of visually significant cataract and associated factors among older people attending community ophthalmic services in the central Gondar Zone, Northwest Ethiopia.MethodsWe conducted a community outreach-based cross-sectional study among adults aged ≥40 years in the central Gondar Zone from 30 May to 15 June 2021. We used systematic random sampling to select study participants. Interviewer-administered questionnaires and ocular examinations were performed and the data recorded. We applied binary logistic regression to identify factors associated with visually significant cataract.ResultsA total of 821 participants were included, with median age 57 years. The prevalence of visually significant cataract was 29.1% (95% CI: 26.1–32.0). Age ≥80 years (adjusted odds ratio [AOR] = 16.9; 95% CI: 7.5–38.4), rural residence (AOR = 1.7; 95% CI: 1.02–2.7), unmarried status (AOR = 1.9; 95% CI: 1.2–3.2), illiteracy (AOR = 2.9; 95% CI: 1.4–6.1), unemployed status (AOR = 1.7; 95% CI: 1.1–2.7), and sunlight exposure ≥5 hours per day (AOR = 1.6; 95% CI: 1.04–2.4) were significantly associated with visually significant cataract.ConclusionIn this study, visually significant cataract was found to be high, which requires immediate public health intervention.

Clinical and genetic findings in TRPM1-related congenital stationary night blindness.

Congenital stationary night blindness (CSNB) is a heterogeneous group of Mendelian retinal disorders that present in childhood. Biallelic variants altering the protein-coding region of the TRPM1 gene are one of the commonest causes of CSNB. Here, we report the clinical and genetic findings in 10 unrelated individuals with TRPM1-retinopathy. Study subjects were recruited through a tertiary clinical ophthalmic genetic service at Manchester, UK. All participants underwent visual electrodiagnostic testing and panel-based genetic analysis. Study subjects had a median age of 8 years (range: 3-20 years). All probands were myopic and had electroretinographic findings in keeping with complete CSNB. Notably, three probands reported no night vision problems. Fourteen different disease-associated TRPM1 variants were detected. One individual was homozygous for the NM_001252024.2 (TRPM1):c.965 + 29G>A variant and a mini-gene assay highlighted that this change results in mis-splicing and premature protein termination. Additionally, two unrelated probands who had CSNB and mild neurodevelopmental abnormalities were found to carry a 15q13.3 microdeletion. This copy number variant encompasses seven genes, including TRPM1, and was encountered in the heterozygous state and in trans with a missense TRPM1 variant in each case. Our findings highlight the importance of comprehensive genomic analysis, beyond the exons and protein-coding regions of genes, for individuals with CSNB. When this characteristic retinal phenotype is accompanied by extraocular findings (including learning and/or behavioural difficulties), a 15q13.3 microdeletion should be suspected. Focused analysis (e.g. microarray testing) is recommended to look for large-scale deletions encompassing TRPM1 in patients with CSNB and neurodevelopmental abnormalities.

Clinical Characteristics of Patients with Glaucoma Presenting to Bharatpur Eye Hospital: An Observational Study.

Glaucoma is the second leading cause of blindness worldwide. Glaucoma will affect 79.6 million individuals by 2020, according to projections. Improved glaucoma screening and treatment approaches are urgently needed. The purpose of this study is to determine the clinical characteristics of glaucoma patients who visit Bharatpur Eye Hospital and aims to calculate the number of new diagnoses of glaucoma from 01 February 2020 to 15 March 2020. This is a hospital-based, cross-section study. All patients with a diagnosis of glaucoma were invited to participate. The examination findings, diagnosis, and management were all documented. A standardized questionnaire was used to collect patient knowledge and understanding of glaucoma. Among 127 patients 52.8% were newly diagnosed with glaucoma. Many patients (59.8%) were symptomatic for more than 6 months. The mean presenting intraocular pressure was 20.86 mm Hg with an SD of 11.55 mm Hg. Only 44.9% of the participants had heard about glaucoma. Many participants (65.4%) did not have knowledge of glaucoma. Among 127 participants 9.4% had a family history of glaucoma. Glaucoma is a significant burden that presents challenges to ophthalmic services in Chitwan. Many people have a poor understanding of their condition and have limited access to services. There is a need to build a treatment infrastructure and raise public awareness.

Glaucoma - the significant challenge for the healthcare system in Poland

Introduction&#x0D; Glaucoma is a group of optic neuropathies characterized by progressive degeneration of retinal ganglion cells (RGCs) and visual field loss. Glaucoma is the leading cause of irreversible blindness in the world. The World Health Organization classifies it as a social and civilization disease and emphasizes the need to improve ophthalmic care systems in order to meet the constantly growing challenge for public health, which is glaucoma. The aim of this article is to identify the main problems that affect the health care system of patients with glaucoma in Poland.&#x0D; Review methods&#x0D; The review of literature on glaucoma was performed using the PubMed and Google Scholar databases. The latest available epidemiological data and the current legal acts concerning the health care system of patients with glaucoma in Poland were also analyzed.&#x0D; Abbreviated description of the state of knowledge&#x0D; The incidence of glaucoma in Poland is constantly increasing, due to the aging of the population. The insidious course of the disease, low public awareness and difficulties in access effective ophthalmic services mean that the disease is diagnosed too late, when significant damage to the optic nerve has already occurred. In addition, the poor mental health of patients, treatment difficulties related to the frequent comorbidity of general diseases and the use of other drug therapies, complicate the course of glaucoma and make it difficult to inhibit its progression.&#x0D; Summary&#x0D; Glaucoma is a significant challenge for public health and the healthcare system in Poland. Therefore, it is very important to take systemic measures as soon as possible that contribute to improve public awareness of eye diseases, increase the availability of ophthalmic care, early detection and appropriate monitoring of the course of glaucoma.

Social media and ophthalmology: A review.

Social media is being widely used across ophthalmology. Its communication tools have been employed more often by ophthalmologists in private practice than academia, although academic institutions may be more impactful influencers. There are opportunities to promote ophthalmic services and to augment traditional clinical care. Social media provides a medium to disseminate peer-reviewed literature in ophthalmology, and to expand conference experiences. It is used for teaching ophthalmology at medical schools and attracting medical students into ophthalmology training, and for research in ophthalmology. Important considerations when using social media include the required time commitment and the public nature of interactions. The high level of misinformation in medical social media remains a challenge for both ophthalmologists and their patients, and the ophthalmologist can play an active role in addressing the issue. This review considers the role that social media is playing in ophthalmology today, including impact on ophthalmic practice, applications in ophthalmic education and training, and patient-focused networking.

Cytomegalovirus retinitis and antiretroviral treatment: A fifteen year experience.

BackgroundSouth Africa’s public antiretroviral treatment (ART) programme has undergone progressive changes since its introduction in 2004. The effect of this on the burden of the AIDS-defining opportunistic infection, cytomegalovirus retinitis (CMVR), in SA, has not been fully appreciated.ObjectivesTo determine the effect of ART availability in the public sector of SA on the trend in the number of cases of newly diagnosed CMVR over time.MethodsThis is a retrospective study from 01 November 2002 to 31 August 2017 that took place at a tertiary hospital in the KwaZulu-Natal (KZN) province.ResultsA total of 383 participants were included in the study, with 60.1% being female and 94% of black African origin. The mean age of patients was 34.08 years (SD ± 7.24). A linear trend model suggested an overall linear decrease in the number of new cases of CMVR per year (R2 of 0.67). The average number of new cases of CMVR per year prior to ART being available to all persons living with HIV (PLWH) with a CD4+ ≤ 350 cells/μL and after was 34 and 13, respectively, and the difference (61.76%) between these values was statistically significant, P = 0.001. The median CD4+ count at diagnosis of CMVR was 22 (interquartile range: 9–51.25) cells/μL. An overall 51% of patients in this study were on ART at diagnosis of CMVR. There was a higher proportion of patients on ART ≤ 6 months (63.3%), compared with those on ART > 6 months (36.7%), and the difference was statistically significant, P < 0.01.ConclusionART has resulted in a decrease in the burden of CMVR on ophthalmic services for many in KZN, particularly following the introduction of ART for all PLWH with a CD4 ≤ 350 cells/μL.

International survey of ophthalmic anaesthesia service provision, protection of anaesthesia providers and patients during COVID-19 pandemic: a wake-up call.

AimsThis international survey was conducted to study the impact of Covid-19 pandemic on the provision and practices of ophthalmic anaesthesia, evaluate the methods employed by parent ophthalmic units for safeguarding their anaesthesia providers and patients during lockdown, and to assess pandemic’s effect on anaesthesia providers as individuals. The study was done with the hope that the results will help in protecting patients and safeguarding precious human resource by better management if this pandemic was to continue or there was to be another pandemic.MethodsAn anonymous questionnaire survey was distributed electronically between December 2020–January 2021 to the practicing ophthalmic anaesthesia providers in different parts of the world.ResultsThe survey identified that apart from reducing elective operating services, the ophthalmic units were ill prepared for the pandemic and the overall management was lacklustre. There was a definite lack of effective peri-operative patient screening, and, streaming processes. Measures for personal protection of staff were not optimal especially during regional/local ophthalmic anaesthesia. Severity of the pandemic, sudden job plan changes, and redeployment to intensive care units/acute covid wards had an adverse psychological impact on the affected staff.ConclusionOphthalmic anaesthesia services worldwide have had poor attentiveness to the life-threatening menace and reality of Covid-19 pandemic. A review of the institutional practices to address correctible deficiencies is urgently required. Robust, mandatory, elective, timely preventative strategies need to be implemented to protect patients, and, the precious ophthalmic workforce from potential adverse physical and psychological injuries.

Impact of COVID-19 pandemic on ophthalmic presentations to an Australian outer metropolitan and rural emergency department: a retrospective comparative study

BackgroundTo analyse ophthalmic presentations to an outer metropolitan and a rural emergency department (ED) during the first wave of the COVID-19 pandemic in New South Wales (NSW), Australia.MethodsA retrospective comparative study of ophthalmic emergency presentations to Campbelltown Hospital (fifth busiest NSW metropolitan ED; population 310,000) and Bowral and District Hospital (rural ED; population 48,000) before and during COVID-19 was conducted. Patient demographics, triage category, referral source, diagnosis, length of stay, departure status, and follow-up location were assessed from coding data between March 1st to May 31st in 2019 and 2020, corresponding to the peak case numbers and restrictions during the first wave of the COVID-19 pandemic in NSW. Differences before and during COVID-19 were analysed using chi-squared tests or independent sample t-tests.ResultsThere was no change in ophthalmic presentations at Campbelltown (n = 228 in 2019 vs. n = 232 in 2020; + 1.75%, p = 0.12) and an increase at Bowral (n = 100 in 2019 vs. n = 111 in 2020; + 11%, p < 0.01) during COVID-19. Urgent ophthalmic presentations (Triage Category 3) decreased at Bowral (p = 0.0075), while non-urgent ophthalmic presentations (Triage Category 5) increased at both hospitals (Campbelltown p < 0.05, Bowral p < 0.01).ConclusionsThere was no change in the total number of ophthalmic presentations to an outer metropolitan and an increase to a rural ED during the first wave of the COVID-19 pandemic in New South Wales, Australia. A change in the type of ophthalmic presentations at these peripheral EDs suggest that a high demand for ophthalmic services remained despite the pandemic and its associated gathering and movement restrictions. A flexible healthcare delivery strategy, such as tele-ophthalmology, may optimise patient care during and after COVID-19.

Application Research of Artificial Intelligence Screening System for Diabetic Retinopathy.

According to the latest data from the Bureau of Disease Control and Prevention of the National Health and Family Planning Commission, China currently has 199.6 million diabetic patients and has become the world's largest country with diabetes. The prevalence rate is as high as 14.3%, which is much higher than the world average of 5.8%. The primary-level ophthalmic screening service is one of the important tasks to improve primary-level medical services, and the corresponding ophthalmic imaging diagnosis technology is an important support for primary-level medical and health services. Therefore, it is very necessary for us to study the application of artificial intelligence image recognition technology for diabetic retinopathy under the medical consortium mode and to study the precise initial diagnosis, precise referral, and precise follow-up of diabetic retina under the medical conjoined mode, so as to better promote the transformation of the ophthalmology primary service model. Based on this background, in this article, we have proposed and carried out the following solution: (1) diabetes data collation. Based on medical artificial intelligence technology, this paper collected 2,265 electronic medical records from an eye hospital in Ningbo and selected 2,000 qualified medical records for data integration and preprocessing. The contents of electronic medical records mainly include age, gender, and examination records. (2) Establish diabetic retinopathy diagnosis model based on neural network algorithm. This article first uses the classic algorithm of BP neural network for modeling, chooses the Levenberg–Marquardt method as the training function, and selects 10 hidden layer units through comparison experiments. After that, ophthalmologists assessed 80 sets of test results and determined the right diagnosis rate. Finally, this article compares and analyzes the accuracy of the two routes in 80 tests.

Assessing Eye Health and Eye Care Needs Among North American Native Individuals

There are few population-level studies on ophthalmic conditions and services among North American Native individuals. To evaluate whether disparities in ophthalmic conditions and services exist between North American Native individuals and non-Hispanic White individuals in the US. This cross-sectional study used 100% Medicare fee-for-service (MFFS) enrollment data from the Vision and Eye Health Surveillance System (VEHSS) to examine ophthalmic conditions and service use in North American Native individuals and non-Hispanic White individuals in the US. In this study North American Native individuals included those who identified as American Indian, Native Alaskan, Native Hawaiian, and Pacific Islander. Data were analyzed from August 2020 to April 2021. Claims and sociodemographic characteristics were extracted and means computed for categories of ophthalmic conditions and select ophthalmic services. Ophthalmic conditions and services were defined in the VEHSS using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Logistic regression was used to model differences between age-adjusted mean ophthalmic condition and service claim rates among North American Native individuals and non-Hispanic White individuals for each age cohort. Matching ophthalmic condition claim rates and ophthalmic service claim rates was performed to examine disparities by racial group. Mean age-adjusted claim rates for ophthalmic conditions and services among North American Native individuals vs non-Hispanic White individuals per 100 persons. Claims were identified for 177 100 Native American Native individuals and 24 438 000 non-Hispanic White individuals. In 16 of 17 ophthalmic condition categories and 6 of 9 service categories, North American Native individuals had significantly different claim rates from non-Hispanic White individuals. There were higher ophthalmic condition claim rates but lower service claim rates for North American Native individuals (vs non-Hispanic White individuals) for refractive errors (ophthalmic condition, 17.2 vs 11.1; service, 48.3 vs 49.6, respectively; P < .001); blindness and low vision (ophthalmic condition, 1.48 vs 0.75: service, 19.2 vs 20.1, respectively; P < .001); injury, burns, and surgical complications (ophthalmic condition, 1.8 vs 1.7; service, 19.2 vs 20.1, respectively; P < .001); and orbital and external disease (ophthalmic condition, 15.7 vs 13.3; service, 48.3 vs 49.6, respectively; P < .001). For diabetic eye diseases, North American Native individuals had higher ophthalmic condition claim rates (5.22 vs 2.20) but no difference in service claim rates (14.4 vs 14.8; P = .26) compared with non-Hispanic White individuals. In this cross-sectional study, North American Native individuals had higher prevalence of ophthalmic conditions but no corresponding increase in services (treatment for most ophthalmic conditions) compared with non-Hispanic White individuals. These results suggest worse eye health and higher unmet eyecare needs for North American Native individuals with MFFS coverage compared with non-Hispanic White individuals with MFFS coverage.