Ophthalmic Services Research Articles

Prevalence of ocular findings regardless of visual acuity status in older adults from the Brazilian Amazon Region

Recently, it has been recommended that population-based studies report not only frequencies of vision impairment and blindness but also any ocular abnormalities that might lead an individual to seek for eyecare services. The current study aimed to determine prevalence of ocular findings regardless of visual acuity (VA) status in older adults from the Brazilian Amazon Region. Disturbances were grouped into: Eyelids; Anterior Segment; Posterior Segment; Increased intraocular pressure; and Overall Globe. The presence of an ocular finding was considered positive when any abnormality was noted, regardless of VA. Refractive errors were not considered. A total 2384 eligible persons were enumerated and 2041 (85.6%) examined. The prevalence of ocular disturbances in either eye was 87.0% and was associated with male gender, older age, lower education, and rural residence. Overall, main findings were pterygium, cataract, and pinguecula, occurring in 58.8%, 45.4% and 17.4%, respectively. Among individuals with 20/20 VA in both eyes, the most frequent findings were pterygium, pinguecula, and glaucoma cupping, occurring in 47.4%, 31.2% and 6.5%, respectively. The high prevalence of ocular findings observed in this population reinforces that different conditions might not immediately decrease VA but can indicate risk and/or discomfort symptoms and should be considered when planning public health ophthalmic services.

Recurrence of Distensible Orbital Venous-dominant Venolymphatic Malformations After Sclerotherapy Versus Embolization With Excision.

Treatment for orbital venolymphatic malformations (VLMs) commonly includes 3 major options: sclerotherapy, surgery, and embolization followed by surgical excision. Each has certain advantages, although it is not clear whether all are effective. The authors characterize the clinical course for a series of patients with distensible orbital venous-dominant VLM treated with sclerotherapy and/or embolization with excision. In this cross-sectional cohort study, patients affected by distensible orbital venous-dominant VLM presenting to the orbital and ophthalmic plastic surgery service from 2014 to 2020 were identified. Patients were included if they presented with a moderate-flow, distensible venous-dominant malformation associated with Valsalva-related symptoms (e.g., pain, proptosis, and diplopia). Six cases were treated with sclerotherapy. Four underwent multiple treatments, with a mean ± SD of 3.5 ± 2.3 (range 1-7). All patients in this group failed to improve or experienced recurrence of symptoms after sclerotherapy. Twelve cases were treated with embolization and excision. Resolution of symptoms in all 12 cases was noted and maintained for a mean of 3.4 ± 2.1 years. There have been no cases of recurrence. Patients treated with sclerotherapy were more likely to experience recurrence of symptoms compared to those treated with embolization and excision (p < 0.001). Treatment of distensible venous-dominant moderate-flow orbital VLM with sclerotherapy may provide temporary improvement in some cases. However, in the medium to long term, recurrence was universal in this series. Embolization with excision appears to provide more definitive management, avoiding recurrence in all cases for a mean follow-up of 3 years.

Knowledge and Awareness of the Coronavirus Disease and Perceptions Towards Ophthalmic Practice Among Ophthalmologists

Objective:To investigate the level of awareness of ophthalmologists towards COVID-19 and their perceptions towards infection control in ophthalmic practice.Methods:A web-based survey was conducted using Google Forms during the month of December 2020. All ophthalmologists practicing in Sudan were invited to participate in the study. Participants who did not agree to the terms of the electronic consent form presented at the beginning of the questionnaire as well as those who did not complete the survey, were excluded from the analysis. Knowledge of causes, symptoms, and methods of transmission of COVID-19; ophthalmologists’ attitudes and perceptions towards COVID-19 and clinical practice, including contact lens practice, were assessed using a set of 26 multiple-choice close-ended questions.Results:Of the 307 participants, 77.4% were in the age range 30-40 years and 73% were contact lens practitioners. While 96.1% acknowledged the scientific name of COVID-19, 46.9% were aware of its cause. Ophthalmologists aged 40-50 years were more likely to agree that air-puffing tonometer risks infection spread (OR 1.62, 95% CI: 0.27-9.70, p&lt;0.01). Ophthalmologists aged 30-40 years were more likely to agree that a slit lamp shield would reduce infection risk (OR 1.52, 95% CI: 0.33-6.96, p&lt;0.01). Contact lens practitioners were more likely to perceive that frequent replacement contact lens use can increase the infection spread (OR 2.64, 95% CI: 1.17-5.94, p&lt;0.01).Conclusion:Ophthalmologists in Sudan demonstrated a mixed level of knowledge of the causes, symptoms, and modes of transmission of COVID-19. While the majority were able to identify the protective measures generally required by medical practitioners and patients, there was a limited level of knowledge regarding protective measures specific to ophthalmic practices, especially when dealing with contact lenses. Official national guidelines about safe ophthalmic service provision during the COVID-19 pandemic are recommended.

A proposed redesign of elective cataract services in Scotland – pilot project

BackgroundThe demand for cataract surgery is expected to increase by 25% in the next 10 years as the result of our ageing population. A new pathway is being proposed to improve efficiency by utilising the new General Ophthalmic Services code 2.9 for community optometrists in Scotland for Cataract Referral Refinement and Consenting process. A pilot project has been undertaken at NHS Grampian enabling patients to be assessed and undergo surgery at a single visit to the Eye Outpatient Department.ObjectivesTo determine the suitability of community cataract referrals for a one stop cataract surgery service and target areas for referral refinement.Methods300 consecutive cataract referrals were assessed for suitability for one stop cataract surgery, determined by the documentation of pertinent clinical findings. All suitable referrals were offered a telephone consultation to confirm suitability and those patients were subsequently offered on the day cataract surgery. A telephone led patient satisfaction survey was then completed.Results71 (24%) suitable patients were identified from vetting 300 referrals. 54 patients from this group were selected for one-stop service following telephone consultation. 51 patients subsequently attended for surgery. There was a 100% conversion rate to same day surgery and no intraoperative complications reported.ConclusionThe waiting time was significantly reduced, by 30 weeks, for one-stop patients. Approximately one quarter of referrals were deemed suitable for a one-stop service. Many more patients may have been suitable for same day surgery but there was not sufficient information in their referrals to determine their suitability.

Ophthalmic services in Shanghai 2017: a cataract-centric city-wide government survey

BackgroundDemand for eye care has increased in recent decades in China due to rapid socioeconomic development and demographic shift. Knowledge of output and productivity of ophthalmic services would allow policymakers to optimize resource allocation, and is therefore essential. This study sought to map the landscape of ophthalmic services available in Shanghai, China.MethodsIn 2018, a government-led survey was conducted of all 86 tertiary/secondary hospitals and five major private hospitals providing eye care in Shanghai in the form of electronic questionnaire, which encompassed ophthalmic services (outpatient and emergency room [ER] visit, inpatient admissions, and surgical volume) and service productivity in terms of annual outpatient and ER visits per doctor, inpatient admissions per bed, and surgical volume per doctor. Comparisons were made among different levels of hospitals with categorical variables tested by Chi-square analysis.ResultsThe response rate was 85.7%. The Eye and Ear, Nose, and Throat (EENT) Hospital was the largest tertiary specialty hospital, and alone contributed to the highest 21.0% of annual ophthalmic outpatient and ER visits (visits per doctor: 5460), compared with other 26 tertiary hospitals, 46 secondary hospitals and five private hospitals (visits per doctor: 3683, 4651 and 1876). The annual inpatient admission was 20,103, 56,992, 14,090, and 52,047 for the EENT Hospital, all the other tertiary hospitals, secondary hospitals and five private hospitals, respectively. Turnover rates were highest for the EENT Hospital and private hospitals. The average surgical volume at the EENT Hospital was 72,666, exceeding that of private (15,874.8) and other tertiary hospitals (3366.7). The EENT Hospital and private hospitals performed 16,982 (14.2%) and 55,538 (46.6%) of all cataract surgeries. Proportions of both complicated cataractous cases and complicated cataract surgeries at the EENT Hospital was the highest, followed by other tertiary and secondary/private hospitals (P < 0.0001).ConclusionsIn Shanghai, public providers dominate ophthalmic services especially for complicated cases, with almost one fifth of services provided by the EENT Hospital alone, while private sectors, though not large in number, still effectively help meet large proportions of eye care demand. Optimization of hierarchical medical system is warranted to improve the efficiency and standardization of ophthalmic services.

Ретроспективный анализ региональных особенностей кадрового обеспечения офтальмологической службы Украины

Актуальность. Реализация приоритетного научно обоснованного направления предупреждения возникновения инвалидности по зрению с детства предусматривает решение многочисленных медико-социальных и медико-организационных задач, связанных с усилением профилактического вектора оказания медицинской помощи детям, своевременным выявлением, лечением заболеваний глаза и его придаточного аппарата. Не теряют актуальности с годами исследования региональных особенностей оказания офтальмологической помощи и состояния офтальмологического здоровья населения всех возрастов с целью поиска путей оптимизации предоставления офтальмологической помощи, важной составляющей которого остается кадровый компонент. Целью исследования стало изучение динамики и региональных особенностей кадрового обеспечения оказания офтальмологической помощи населению Украины. Материалы и методы. Материалами для исследования послужили данные официальной статистической отчетности за период 2005–2014 гг., а именно формы: № 20 «Отчет лечебно-профилактического учреждения» (годовая) (268 ед.); № 17 «Отчет о медицинских кадрах» (годовая) (268 ед.); № 21-А «Отчет о медицинской помощи роженицам, новорожденным и детям первого года жизни» (годовая) (268 ед.), собранные по отдельным административным территориям Украины (всего 804 ед.). Изучение первичного материала предусматривало применение методов системного подхода и анализа, эпидемиологического, медико-статистического методов исследования и контент-анализа. Результаты. Выявлены тенденции к уменьшению численности офтальмологов в Украине, в том числе детских, с региональными особенностями увеличения их численности в отдельных областях преимущественно Западного и Центрального макрорегионов. Несмотря на колебания показателя обеспеченности офтальмологами в расчете на 10 тыс. населения, высокой она обнаружена была в г. Киеве (1,49), Львовской (1,05) и Запорожской (1,0) областях при среднем по Украине значении 0,74 на 10 тыс. населения. Низкая обеспеченность офтальмологами обнаружена, кроме Донецкой (0,25), Луганской (0,18), в Херсонской (0,57), Николаевской (0,59) и Кировоградской (0,61) областях. Вместе с уменьшением абсолютного количества врачей-офтальмологов в Украине уменьшилась и укомплектованность должностей офтальмологов при среднем по Украине значении 90,25 %. Результаты ретроспективного исследования выявили постепенное уменьшение численности детских офтальмологов в Украине одновременно с ростом процента детских офтальмологов пенсионного и предпенсионного возраста, который по итогам 2014 г. составил 31,7 %. При постепенном уменьшении количества зарегистрированных должностей детских офтальмологов их укомплектованность колеблется в пределах 86,33 %. Региональные особенности обеспеченности детскими офтальмологами проявились почти двойным ростом показателя в Закарпатской, Ивано-Франковской, Львовской, Ровенской и Черновицкой областях при высоких значениях в г. Киеве. Выводы. В Украине происходит постепенное уменьшение как абсолютного количества офтальмологов (–16,1 %), в том числе детских (–25,14 %), так и обеспеченности ими (–8,64 и –20,0 % соответственно) при одновременном уменьшении (на 4,4 %) укомплектованности их должностей (с 94,4 в 2005 г. до 90,25 в 2014 г.). Региональные особенности кадрового обеспечения детской офтальмологической службы заключаются в росте обеспеченности офтальмологами в областях Западного и Центрального макрорегионов Украины (Киевская — +48,8 %, Львовская — +25,0 %) с традиционно высокой обеспеченностью офтальмологами, в том числе детскими в г. Киеве (1,49 и 0,22 соответственно) и Львовской (1,05 и 0,19 соответственно) области. В то же время обеспеченность детскими офтальмологами в Кировоградской (0,06), Черкасской (0,06) областях остается очень низкой, за период исследования абсолютное количество детских офтальмологов в этих областях уменьшилась почти вдвое. Половина (52,9 %), а в некоторых областях и большая половина (Одесская — 72,3 %, Львовская — 68,2 %) практикующих офтальмологов имеют высшую квалификационную категорию, что свидетельствует об их профессионализме, высоком уровне знаний и длительном опыте работы.

Impact of COVID-19 on Ophthalmic Outpatient Services in An Eye Care Center in Southern Nigeria.

Coronavirus disease-2019 (COVID-19) is a communicable disease and a global pandemic affecting different parts of the world including Nigeria. Measures to curb the spread of the causative virus included a nationwide lockdown. The aim of this study was to assess the impact of COVID-19 on ophthalmic outpatient services in an eye care center in Nigeria. The medical statistics for all persons attending the Ophthalmic Outpatient Clinic from January to August 2020 and January to August 2019 was obtained. The statistics for January to August 2020 was compared with that of the corresponding months in 2019 for outpatient clinic attendance, gender, and number of children and adults. In the 2019 study period, the total number of patients attending the Ophthalmic Outpatient Clinic was 16,189. There were 6788 males, 9401 females, 2963 children, and 13,226 adults. In similar months in 2020, the total number of patients was 8,735, of which 3,934 were males, 4801 females, 1651 children, and 7084 adults. There was an overall decline of 46% in the number of outpatient attendance in 2020. The decline was 76.3% in April 2020 (peak of the lockdown). There was a rebound in outpatient visits in July 2020 (when the interstate travel ban was lifted) to 4.9 times that of April 2020; however, this was 56.9% that of July of the preceding year. COVID-19 pandemic impacted negatively on outpatient visits. A rebound in the number of visits was observed when the interstate travel ban was lifted, although far below the preceding year's value.

How accessible is primary eye care for children in England?

Good vision during childhood is vital for visual, educational, and social development. Previous research highlights challenges in the accessibility of eye care for children. This study investigates the accessibility of primary eye care for young children with typical development and those with autism in England. A telephone survey was conducted using four hypothetical scenarios (a child aged 1, 3, 5years and a 13-year-old with autism). Four hundred community optometric practices (100 different practices for each scenario) were contacted to explore the availability of an eye examination. The caller acted as a parent, asking about the availability of an eye examination for their child and raising concerns regarding the child. Key barriers and enablers to the accessibility of primary eye care were identified through an analysis of qualitative information. Of the 400 practices, only three (<1%) stated that they do not perform eye examinations on children. Fifty-six practices (14%) stated that they would examine a child at any age, the remainder (n=341, 85%) specifying a minimum age at which they would perform eye examinations on children. Lack of 'communication' from the child and 'equipment' were identified as barriers to accessing eye care for young children. Eye care for children with autism was enabled by factors related to adaptability and appointment time. Our results suggest that communication and a lack of appropriate equipment for examining children are potential barriers to accessing primary eye care. No clear barriers were identified for an older child with autism. Eye examinations are more accessible for older children in these scenarios (aged 5 with typical development and 13years with autism) than younger children (aged 1 and 3years old). While the UK General Ophthalmic Services (GOS) terms do not permit contract holders to exclude categories of patients from a GOS eye exam, our findings suggest this is taking place.

The Profile of Secondary Glaucoma in China: A Study of Over 10,000 Patients.

Few studies have investigated the epidemiology of secondary glaucoma (SG) in China. This study analyzed the current profile of admitted patients with SG at the largest ophthalmic center in China. SG cases were retrieved retrospectively by International Classification of Disease-10 clinical coding data from January 2010 to December 2019. Demographic data, etiologies, and the management of SG were analyzed. The ratios of the etiologies were compared with previously reported data from other regions. The etiologies and management between the 2010 to 2014 group and the 2015 to 2019 group were compared. A total of 11,730 cases were enrolled. The mean age of the patients with SG was 44.45±19.45 years old. Men (66.94%) were more vulnerable than women (33.06%). The etiologies of SG in 2010 to 2019 were trauma (28%), vascular disease (18%), lens-induced (9%), inflammation (11%), drug-induced (2%), anterior segment surgery (7%), posterior segment surgery (11%), syndrome-associated (4%), and tumors (1%). Compared with other regions, our data have a higher proportion of trauma and vascular disease-associated SG. Compared with 2010 to 2014, trauma-induced SG declined, and drug-induced SG, anterior segment surgery, and syndrome-associated SG increased in 2015 to 2019 (P<0.001). Vascular disease-associated SG cases were older than trauma-induced SCs and had a higher percentage in retired patients (P<0.001), whereas trauma-induced SGs were more prevalent in pediatric patients than vascular disease-related SGs (P<0.001). In addition, the application of drainage device implantation, cataract surgery, and cyclophotocoagulation increased, whereas trabeculectomy and anterior chamber paracentesis and cyclocryotherapy decreased in 2015 to 2019 (P<0.005). Although the etiology spectrum has changed during the last 10 years, trauma and vascular disease are still common causes of SG in southern China. Traditional antiglaucoma surgery decreased gradually, and more advanced treatments emerged for its treatment. Up-to-date knowledge of SGs reflects the impact of economic development and ophthalmic service improvement on SGs and is of great value for ophthalmologists to detect SGs early and manage them in a timely manner.

Distribution and determinants of hospital efficiency and relative productivity in county-level hospitals in rural China: an observational study

BackgroundCataract surgery is very important to prevent blindness, but its productivity and efficiency in China are unknown. Our study aimed to evaluate the geographical distribution of cataract surgeons and prospectively...

A Review of Ophthalmic Telemedicine for Emergency Department Settings

ABSTRACT Background: Patients presenting to emergency departments for ophthalmic emergencies benefit from prompt evaluation. However, Few emergency departments (EDs) have ophthalmologists on call, and eye care provided in EDs without ophthalmic services can be inaccurate. Methods: We review the current state of ophthalmic telemedical care in EDs and highlight important considerations when implementing telemedicine in this setting. Results: Telemedicine allows ophthalmologists to work with on-site emergency care providers to interview and examine patients remotely in EDs, enabling proper assessment of patient history, visual acuity, pupils, intraocular pressure, as well as the anterior and posterior segment. To date, patients’ perceptions of this new model of care have been largely positive. Discussion: The use of telemedical consultations for remote evaluation of patients with ophthalmic complaints stands to improve the quality of care provided to patients and extend the reach of remote ophthalmologists. The onset of the COVID-19 pandemic and the risk of in-person care further highlights the potential for telemedicine to augment existing models of emergency care.

Prevalence of common mental disorders and associated factors among adults with Glaucoma attending University of Gondar comprehensive specialized hospital tertiary eye care and training center, Northwest, Ethiopia 2020.

PurposeThis study aimed to assess the prevalence of common mental disorders and associated factors among adults with glaucoma at Gondar university comprehensive specialized hospital tertiary eye care and training center. Glaucoma predisposes patients to common mental problems and leads to wasteful, costly and inefficient use of medical services and complications of the diagnoses. So, determining the level and factors associated with common mental disorders among glaucoma patient would help to improve and integrate comprehensive ophthalmic services which address common mental disorder in a follow-up visit.MethodsAn institution-based cross-sectional study was conducted on 495 glaucoma patients selected by using systematic random sampling. Data were collected through face-to-face interview and chart review. Self-reported questionnaire (SRQ-20) was used to assess the presence of common mental disorders. Binary logistic regression analysis was done to identify factors associated with common mental disorders. Variables with P<0.05 were considered as factors significantly associated with common mental disorders.ResultFour hundred sixty-eight patients were included in this study with a response rate of 94.54%. The mean age of the participant was 58 ± 14.11 years. The prevalence of common mental disorders was found to be 29.5% (95% CI 25.4–33.3). Female sex (AOR = 3.79, 95% CI: 1.66–8.62) (p-value = 0.001), average monthly income of less than 1200 birr (AOR = 6.05 95% CI: 2.26–16.22) (p-value = 0.001), poor level of social support (AOR = 17.39 95% CI: 7.79–38.82) (p-value = 0.001), moderate and high risk of alcohol use (AOR = 10.42 95%CI: 2.74–39.54) (p-value = 0.001), presence of chronic medical illness (AOR = 3.85 95% CI: 2.07–7.16) (p-value = 0.001), receiving both drug and surgical treatment (AOR = 2.50, 95%CI: 1.30–4.83) (p-value = 0.006) and presence of systemic carbonic anhydrase inhibitors use (AOR = 3.16, 95%CI: 1.65–6.06) (p-value = 0.001) were significantly associated with increased level of common mental disorders.ConclusionSignificant numbers of glaucoma patients have CMD and found significantly associated with socio-economic, ocular and systemic clinical factors. Therefore, the integration of psychosocial care into the current treatment of patients with glaucoma would have a significant advantage to help these patients.

The Impact of COVID-19 on Acute and Elective Corneal Surgery at Moorfields Eye Hospital London.

PurposeMoorfields Eye Hospital sits as a major tertiary centre for ophthalmic care in the United Kingdom and became a central hub to provide safe and effective ophthalmic care across London and surrounding regions during the COVID-19 pandemic. We explore the impact on both the acute and elective corneal services during the first wave of this pandemic.MethodsA retrospective review of the proportion of corneal transplants and anterior segment trauma repairs was performed during the period of March 23rd to July 1st 2020 compared with an identical period in 2019. Data were acquired from our in-house electronic patient records.ResultsA 92% reduction in corneal elective work was observed during the lockdown period compared with an identical period in 2019, with only 10 elective cases in total being performed. In addition, 91 corneal cross-linking and 76 therapeutic lasers were cancelled. There were 15 cases of primary repair for anterior segment trauma compared with 6 cases pre-COVID-19. A similar scenario occurs with removal of foreign body (4 cases during COVID-19 period versus no cases during pre-COVID-19 era) and with traumatic lens aspirations (6 cases during COVID-19 compared with 2 pre-COVID-19). Interestingly, a statistical difference (p=0.03) was found in the time interval from presentation of symptoms to emergency corneal surgery. During the COVID-19 period, a delay of 1.5 days ± 2.29 (range 0–10 days) occurred compared with 0.8 days ± 1.54 (range 0–6 days) pre-COVID-19.ConclusionStringent risk stratification reduced elective corneal surgery capacity during the lockdown thereby preserving social distancing requirements. However, an apparent increase in emergency corneal surgery seen is likely attributed to centralisation of ophthalmic services during the pandemic crisis, alongside increased domestic injuries. Despite the challenges posed, successful delivery of corneal surgery occurred whilst helping to identify lessons in preparations for future pandemics and current inefficiencies in healthcare delivery.

The Mobile Teleophthalmology Unit in Rural and Underserved Areas of South India

Objective: Our objective was to provide an eye care service to rural and underserved areas in Chennai, Kanchipuram, and Thiruvallur districts of Tamil Nadu, South India. Design: We conducted eye camps to provide ophthalmic services to the underserved and rural areas, where people cannot afford to go to a hospital due to lack of accessibility, lack of awareness, or financial constraints. Setting: The study was conducted in rural and underserved areas of Thiruvallur, Chennai, and Kanchipuram districts from January 2015 to December 2019. Participants: Patients (N = 1,05,827) underwent comprehensive eye examination in eye camps with the state-of-art ophthalmic equipment. Main outcome measures: To report on the number of patients examined, number of eye disorders screened, and different types of ocular pathology screened, all clinical findings were recorded and all ocular images were uploaded in the electronic medical records. All patients with ocular diseases underwent teleconsultation with an ophthalmologist at the base hospital with internet connectivity. Video conferencing and teleconsultation were feasible only in areas with good internet connectivity. Results: Over the 5-year study period, 1,05,827 patients underwent eye evaluation at 1,061 eye camps. Among these, 48,354 (45.7%) patients were males, 57,473 (54.3%) patients were females, 15,515 patients were emmetropes. The most common cause of avoidable blindness was uncorrected refractive error detected in 66,137 eyes, referable cataract was seen in 13,536 eyes, 2,491 eyes were identified to have retinal diseases, and there were 789 patients with only diabetic retinopathy, thus totaling to 3,280 comprising of all retinal disease. 2424 patients received teleconsultations. For further investigations and treatment, which were provided free of cost, patients were referred to the base hospital in Chennai. There were 6,309 patients who received free spectacles and an additional 31,192 patients received spectacles at a low cost; 13,536 patients had referable cataract and were referred to the base hospital for further evaluation and surgery. Conclusions: Teleophthalmology holds great potential to overcome barriers, improve quality, access, and affordability to eye care, and has proven to be an innovative means of taking comprehensive eye care facilities to the doorsteps of rural India.

Socio-economic differences in accessing NHS spectacles amongst children with differing refractive errors living in Scotland

Background/objectivesAdults living in more deprived areas are less likely to attend an eye examination, resulting in greater visual impairment from undiagnosed eye disease and a widening of health inequalities. It is unknown if the introduction of free NHS eye examinations and help with spectacle costs has benefited children in Scotland. This study aimed to explore factors associated with accessing NHS spectacles including level of deprivation, refractive error, urbanity and age.Subjects/methodsNHS-financed General Ophthalmic Services (GOS) 3 supplement the cost of spectacles for children under 16 years. Administrative data on the spectacle refraction dispensed were obtained from Information Services Division (ISD) for mainland Scotland, 2018, and categorised by: Emmetropes/low hyperopes (reference group), myopes and moderate/high hyperopes. Data were linked to the Scottish Index of Multiple Deprivation (SIMD) quintile.ResultsData included 108, 043 GOS 3 claims. Greater deprivation was associated with greater GOS 3 claims p = 0.041. This was most evident in emmetropic/low hyperopic children and in moderate/high hyperopic children. GOS 3 claims in the myopes group increased with age across all SIMD and decreased with age in the moderate/high hyperope group (all p < 0.001). GOS 3 claims were not associated with urbanity for all Health Boards (p = 0.13).ConclusionsChildren in areas of greater deprivation and in more rural areas are not disadvantaged in accessing NHS spectacles. This did not vary by refractive error group. This suggests that health policy in Scotland is accessible to those from all deprivation levels and refractive errors.

Consent and capacity confidence and knowledge within optometric practice in Scotland.

With the remit of the optometric workforce expanding amidst a growing population, education around consent and capacity is crucial. The aim of this study is to gain an understanding of the current confidence and knowledge around consent and capacity within the optometric workforce in Scotland, to elicit whether there is an interest for training and education on the topic and to highlight areas of misunderstanding. Results will guide the content for the 2020 General Ophthalmic Services (Scotland) Mandatory Training module and any further workstreams. The optometric workforce in Scotland was invited to participate in a voluntary online survey, open for 50days in May 2019. The final survey consisted of 15 closed-ended questions and six open-ended questions, with an additional eight routed questions that were only available if respondents gave a particular response to one of the 15 bulk closed-ended questions. The survey covered the following areas: respondent demographics; consent in optometric practice in Scotland; adults with incapacity in optometric practice in Scotland; education around consent and capacity; The Adults with Incapacity (Scotland) Act 2000 and a final open question. One hundred and forty-seven valid responses were received (9.1%): 85.7% were interested in future education around consent and capacity; 8.3% were not interested in training to allow them to issue a certificate of incapacity, with the remainder interested (37.2%) or requiring further information (54.5%). Sixty percent were moderately or very confident assessing a patient's capacity to consent and 74.8% were moderately or very confident at performing an eye examination on a patient who lacks capacity for all or part of the appointment or patient journey. Of respondents, 48.3% had either 'never heard of' or would rate themselves as 'not at all knowledgeable' of the Adults with Incapacity (Scotland) Act 2000 and 60.5% regarding certificates of incapacity. No respondents rated themselves as very knowledgeable and 15% or less felt they were moderately knowledgeable in either area. Although there is moderate confidence around consent and capacity within the optometric workforce in Scotland, there is a lack of knowledge. Consent and capacity education is critical, and significant interest in such exists. The optometric workforce in Scotland must be supported to deliver safe and appropriate care in-line with the Adults with Incapacity (Scotland) Act 2000.

Sustaining ocular emergency and trauma services in corona crisis during the era of pan lockdown

Background: The impact of covid pandemic and pan lockdown on the ocular trauma and emergency department has proved the importance of ocular trauma services deliverance on national vision statics. The un-availability of ophthalmic services in remote areas and limited resources have large impact on prognostic outcomes of ocular emergencies. The presentation of ocular emergency cases and their demographic pattern is important in planning and programming of national strategy to cope up with and sustain the ocular emergency services during such pandemics.Methods: Retrospective cohort study at tertiary care center.Results: The incidence of ocular trauma was increased in male pediatric age group with most common mode of injury was wooden objects. The prognosis of visual outcome was ill- affected due to late presentation and un-availability of ocular emergency services in remote areas.Conclusions: The strategy of “Reassess-Reinforce-Resume” was proved successful in sustaining the emerging trend of ocular trauma during COVID pan- lockdown.

Magnitude of visual impairment and associated factors among patients attending ophthalmic clinics of Debre Markos referral hospital, north West Ethiopia

BackgroundGlobally, visual impairment affects about 285 million (4.25%) people, of those, 266.4 million were adults aged 18 years and above. Ethiopia is one of developing countries estimated to have high prevalence of visual impairment which have an enormous socio-economic impact. Also there is limited available information regarding with the magnitude of visual impairment among adults in our country at large and east Gojjam zone in specific. Therefore the aim of this study was to assess the magnitude of visual impairment and its associated factors among patients attending Debre Markos Referral Hospital ophthalmic clinics in east Gojjam zone, North West Ethiopia.MethodsAn institutional-based cross-sectional study was conducted at Debre Markos Referral Hospital which is the only hospital in east gojjam zone with ophthalmic care service from March 1 to 30, 2020 by using systematic random sampling technique to select study participants after informed consent was obtained.Data were collected by interview with 5% pretested, structured questionnaire and ocular examinations. Data were cleaned, coded and entered to Epi-data version-3.1, and analyzed using Statistical Package for Social Science software version 26. The descriptive statistics was presented in tables, text and graphs. Bivariable and multivariable logistic regression analysis to identify factors associated with visual impairment was conducted. Covariates with P-value < 0.05 were considered statistically significant.ResultsA study was conducted among 312 study participants with 96% response rate. The magnitude of visual impairment was 114 (36.5%) [95% CI, (33.8, 39.2%)]. Age > 50 years [AOR = 3.82; 95% CI (1.56, 9.35)], rural residency [AOR = 4.33 95% CI (1.30, 14.44)], inability to read and write [AOR = 3.21; 95% CI (1.18, 8.73)] and Cataract [AOR = 4.48; 95% CI (1.91, 10.52)] were factors significantly associated with visual impairment.ConclusionsThe overall magnitude of visual impairment was found to be high. Older age, rural residency, inability to read and write and cataract were associated with visual impairment. Increasing literacy, expanded cataract surgery, as well as community based visual acuity screening especially for elders and rural residents is crucial. Zonal police makers should give emphasis on prevention of visual impairment to decrease economic, social and political burden of visual disability.

School-based vision screening in Quetta, Pakistan: a qualitative study of experiences of teachers and eye care providers

BackgroundVisual impairment in children is a significant public health problem affecting millions of children globally. Many eye problems experienced by children can be easily diagnosed and treated. We conducted a qualitative study with teachers and optometrists involved in a school-based vision screening programme in Quetta district of Pakistan to explore their experiences of training, vision screening and referrals and to identify factors impacting on the effectiveness of the programme.MethodsBetween April 2018 and June 2018, we conducted semi-structured in-depth interviews with 14 teachers from eight purposefully selected schools with high rates of inaccurate (false positive) referrals. Interviews were also conducted with three optometrists from a not-for profit private eye care hospital that had trained the teachers. Interviews were audio recorded and professionally transcribed. NVIVO software version 12 was used to code and thematically analyze the data.ResultsFindings suggest that the importance of school-based vision screening was well understood and appreciated by the teachers and optometrists. Most participants felt that there was a strong level of support for the vision screening programme within the participating schools. However, there were a number of operational issues undermining the quality of screening. Eight teachers felt that the duration of the training was insufficient; the training was rushed; six teachers said that the procedures were not sufficiently explained, and the teachers had no time to practice. The screening protocol was not always followed by the teachers. Additionally, many teachers reported being overburdened with other work, which affected both their levels of participation in the training and the time they spent on the screening.ConclusionsSchool-based vision screening by teachers is a cost-effective strategy to detect and treat children’s vision impairment early on. In the programme reviewed here however, a significant number of teachers over referred children to ophthalmic services, overwhelming their capacity and undermining the efficiency of the approach. To maximise the effectiveness and efficiency of school-based screening, future initiatives should give sufficient attention to the duration of the teacher training, experience of trainers, support supervision, refresher trainings, regular use of the screening guidelines, and the workload and motivation of those trained.

Community optometrist-led post-operative cataract care: how many patients re-present to the hospital ophthalmic department?

BackgroundCataract surgery represents a significant workload for ophthalmologists in Ireland. Post-operative shared care with community optometrists can reduce the need for hospital follow-up appointments.AimsEight years after the introduction of a shared-care pathway, we wished to quantify the proportion of patients discharged to the community for post-operative follow-up, and the number that re-present to the hospital due to cataract-related issues.MethodsWe collected data on all patients who underwent cataract surgery in our centre over a three month period. Electronic patient records were used to establish whether the patient was discharged on the day of surgery, and whether they re-attended the department post-operatively. Post-operative complications were recorded.Results394 cataract procedures were carried out over the three months. 369 patients were discharged to an optometrist for their post-operative care. Of those, 38 were re-referred or re-presented to the hospital ophthalmic service. 21 of these had a post-operative complication. Complications included seven cases of post-operative uveitis, 5 patients with cystoid macular oedema, one retinal detachment and one retained lens fragment.ConclusionsCommunity optometrist-led post-operative care for uncomplicated patients is an effective way of reducing the workload associated with cataract surgery. Re-referral pathways must be in place to facilitate timely management of post-operative complications.