Ophthalmology Service Research Articles

Real-world service costs for neovascular-AMD clinics in the United Kingdom: structured literature review and scenario analysis

Objective Current cost-effectiveness analyses (CEA) emphasize drug costs as the differentiator between NICE recommended anti-VEGF treatments but may neglect real-world non-drug costs of running nAMD services in the UK. To address this, this study identified real-world non-drug service cost items relevant to UK NHS nAMD clinics, including costs arising from operational strain (demand exceeding capacity). Methods Cost items were identified by a structured literature review of peer-reviewed and grey literature, and an expert panel of 10 UK-based ophthalmologists with relevance to real-world practice. These items underwent meta-synthesis and were then determined in a consensus exercise. Results Of 237 cost items identified, 217 (91.6%) met the consensus threshold of >0.51 and were included in the nAMD Service Non-Drug Cost Instrument (nAS). Sensitivity of cost items taken from UK Health Technology Assessment (HTA) using the nAS as the reference standard was low (HTAmin: 1.84%, 95% CI 0.50–4.65%; HTAmax: 70.51%, 95% CI 63.96–76.49%). False negative rates showed variable likelihood of misclassifying a service by cost burden depending on prevalence. Scenario analysis using cost magnitudes estimated annual per-patient clinic cost at £845 (within capacity) to £13,960 (under strain) compared to an HTAmin estimate of £210. Accounting for cost of strain under an assumed 50% increase in health resource utilization influenced cost-effectiveness in a hypothetical genericisation scenario. Conclusion Findings suggested that HTA underestimates UK NHS nAMD clinic cost burden with cost of strain contributing substantial additional unmeasured expense with impact on CEA. Given potential undertreatment due to strain, durability is suggested as one of the relevant factors in CEA of nAMD anti-VEGF treatments due to robustness under limited capacity conditions affecting UK ophthalmology services.

Ultrasound biomicroscopic imaging parameters associated with outcome in equine infectious ulcerative keratitis and stromal abscesses.

To determine the predictive value of corneal ultrasound biomicroscopy (UBM) findings for the outcome of equine corneal disease. 46 horses with a clinical diagnosis of either infectious ulcerative keratitis or stromal abscess. Corneal UBM (VevoMD; UHF70; VisualSonics) of horses with infectious corneal disease presenting to the North Carolina State University Equine Ophthalmology Service from 2019 to 2023 were evaluated. Size and depth of lesion, presence of Descemet membrane disruption (DMD), corneal thickness, and aqueous humor cell counts (AHCC) were assessed. Comparisons of UBM and clinical exam findings, presence of infectious organisms, and outcome (healed or enucleated) were performed. The UBMs from 46 horses were evaluated. Increased AHCC was significantly associated with increased size and depth of corneal lesions on UBM but not with DMD. Deep lesions and DMD were significantly associated with an enucleation outcome. Horses treated with systemic antibiotics had significantly lower AHCC on UBM, but there were no differences in AHCC with the use of other systemic or topical medications. There was no significant correlation between infectious disease results, clinical findings (aqueous flare or cells), outcome, and UBM AHCC. Parameters on UBM, such as depth of lesion, DMD, and AHCC, may be useful diagnostic and prognostic tools to augment the ophthalmic exam of horses with corneal disease. The UBM findings of deep corneal lesions and DMD suggest a poor prognosis and warrant aggressive surgical intervention.

Comparison of preoperative retrobulbar bupivacaine and postoperative subcutaneous liposome-encapsulated bupivacaine on postoperative analgesia in dogs undergoing enucleation.

To compare the effectiveness of preoperative bupivacaine inferotemporal retrobulbar blocks to postoperative liposome-encapsulated bupivacaine (Nocita) line blocks for analgesia following enucleation. 39 client-owned dogs (40 eyes) presenting to the Ophthalmology Service for enucleation. Dogs were randomly assigned to receive either a preoperative inferotemporal retrobulbar block with 0.5% bupivacaine or a peri-incisional line block with liposome-encapsulated bupivacaine (Nocita) at closure. Patients underwent unilateral enucleation and were hospitalized for 24 hours after surgery. Pain scores were performed by a masked observer with the Glasgow Composite Measure Pain Scale and the University of Wisconsin Ocular Pain Scale at 0.25, 0.5, 1, 2, 4, 6, 8, and 24 hours following surgery. Intraoperative use of blood pressure and anesthetic support mediations as well as need for rescue pain control were recorded and compared between groups. There was no significant difference in rescue rates between treatment groups. When comparing the use of medical intraoperative heart rate, blood pressure, or anesthetic plane support, there were no significant differences in use between groups. Use of preoperative bupivacaine retrobulbar blocks and postoperative Nocita line blocks were equally effective at postoperative pain control with similarly low complication rates.

Clinical and epidemiologic characterization of non-infectious uveitis in a university hospital in Paraguay

Clinical and epidemiologic characterization of non-infectious uveitis in a university hospital in Paraguay

100% quality

Nigel Kirkpatrick discusses clinical quality in ophthalmology services and how optimum patient care can be achieved

Центр патологии сетчатки в рамках новой модели организационной структуры по профилю «Офтальмология» при диабетической ретинопатии.

Relevance. The most serious consequences of the global epidemic of diabetes are its systemic vascular complications, one of which is diabetic retinopathy as the most common cause of visual function loss among diabetic patients and the leading cause of blindness and visual impairment among the working population. However, with a well-organized screening system and early detection of this complication, more than 80% of cases of blindness and visual impairment can be prevented or treated. One of such approaches is the establishment of a specialized ophthalmological Center, which will elevate medical care for patients with diabetes complications to a qualitatively new level. Purpose of the study is to evaluate the functional role of the created retinal pathology centre within the framework of the new information and technological model of medical care in the profile «ophthalmology» for diabetic retinopathy in the Tomsk region. Materials and methods. The data of the federal statistical observation form No. 12 were used as materials. Statistical analysis methods: analytical; descriptive statistical method. The critical level of significance was set at p <0.05 (95%). Data processing was carried out using electronic spreadsheets «MSOffice Excel 2010» and the application package «Statistica» for Windows 10.0. Results. In the Tomsk region, a project is being implemented to introduce a unified organizational model of telemedicine service for monitoring diabetic retinopathy based on artificial intelligence technology, including a regional expert Center for retinal pathology as the main organizational and methodological unit, operating in close collaboration with healthcare institutions in the Tomsk region. Тhe Center’s task is early detection of diabetic retinopathy with further organizational and methodological support for identified cases. The activities of the Center are regulated by regional legal documentation aimed at regulating its work and adapting a new patient routing scheme for patients with diabetic retinopathy. The expected results of the project will reduce the predicted visual disability due to diabetic retinopathy in the Tomsk region to 80%, which will have a positive impact on the main performance indicators of the ophthalmological service in the region. Findings. The model allows for the integration of the Center for Retinal Pathology, prevention rooms of medical organizations, including remote municipal entities of the Tomsk region, equipped with ophthalmological fundus cameras for digital retinal photography, the ability to exchange data between networked medical organizations and the Center for Retinal Pathology. All these organizational changes will have a positive impact on reducing the overall prevalence of diabetic retinopathy in the region.

E003 A quality improvement project looking into retinopathy screening for patients taking hydroxychloroquine at the Princess of Wales Hospital

Abstract Background/Aims Hydroxychloroquine (HCQ) is widely used in various rheumatic and dermatological conditions and the risk of associated retinal toxicity is more common than previously considered; an overall prevalence of 7.5% in patients taking HCQ for greater than 5 years, rising to 20 to 50% after 20 years of treatment. The Royal College of Ophthalmologists (RCOphth) revised guidelines (2020) advise annual monitoring of all patients for retinopathy who have taken HCQ for > 5 years. Patients with additional risk factors for retinal toxicity may be monitored annually after the initiation of therapy. Methods We reviewed relevant medical records of all the rheumatology patients at Princess of Wales Hospital (POWH) on HCQ from January 2017 to February 2022. Data was collected to include patient demographics and diagnosis, duration on HCQ, whether retinopathy referral was indicated and requested and whether these patients were subsequently seen in the ophthalmology clinic. Results In total we identified 216 patients, and the median age was 60 (range 27-96). All patients had been informed of potential associated retinopathy and were advised to undergo annual assessment by an optician. 60 of these 216 patients had stopped HCQ for various reasons while 156 remained on it. 79 of these 156 were eligible for referral as per the revised RCOphth guidelines as they had received treatment for at least 5 years. 40 of these 79 were referred to ophthalmology and 15 had been reviewed by the ophthalmology service. None of these 15 patients, however, have had further annual ophthalmology reviews after initial assessment. 39 patients had not been referred to ophthalmology despite being on hydroxychloroquine for more than 5 years. If those at high risk are considered, a further 30 of these 156 patients would be eligible for referral. 14 out of these 30 had been referred and none had yet been seen by ophthalmology. Conclusion Using the criteria defined by the revised guidance, approx. 50% of eligible patients had been referred to ophthalmology; 33% of patients have undergone review. Potential reasons for poor adherence to the RCOphth guidelines would likely include the significant changes in guidelines issued in 2017, 2018 and 2020, lack of resources to cope with additional demand in the ophthalmology service and the COVID-19 pandemic which has resulted in significant delays in outpatient services. Following this project, all eligible patients have been referred to ophthalmology and the findings were shared with the dermatology service who are now undertaking a similar audit project. Given the updated referral criteria, we intend to implement a standard referral proforma to ensure all those at risk of retinopathy are identified and will work closely with ophthalmology colleagues to address how best to improve waiting times for such patients to undergo full assessment. Disclosure A. Anjum: None. S. Safdar: None. S. Duffill: None. C. Jenkins: None. S. Smale: None. U. Srinivasan: None.

The impact of Charles Bonnet syndrome in patients with age-related macular degeneration

Abstract Introduction: Charles Bonnet syndrome (CBS) is a condition related to patients having complex visual hallucinations and visual loss due to ophthalmologic disease, without cognitive impairment. CBS is an important differential diagnosis of dementia syndromes, and the correct diagnosis has a great impact on the quality of life of those who suffer from the stigma of psychiatric disease. Objective: The objective of the present study is to determine the impact and review symptoms of CBS in patients with visual loss due to age-related macular degeneration (AMD) by using a questionnaire. Method: Sixty patients suffering from AMD were forwarded from the Retina Sector of the Ophthalmology Service of the Hospital do Servidor Público Estadual de São Paulo to the Low Vision Sector for a cognitive assessment questionnaire. Results: Of the 60 patients studied, 10 were diagnosed with CBS, thus representing 16.6% of the incidence of CBS cases in individuals with AMD. Among these 10 cases, males represented 30% versus females who represented 70% of the total. Patients over 80 years old represented 50% of those who were diagnosed with CBS. CBS represents an important co-diagnosis in AMD patients. Conclusion: The research highlights the utility of the cognitive assessment questionnaire as a valuable tool for easily diagnosing the syndrome in patients with AMD. This tool facilitates the identification of the condition, enabling the recommendation of appropriate clinical treatments and the provision of essential psychosocial support.

PRESERVING THE HEALTH OF THE ORGAN OF VISION IN CHILDREN: ORGANIZATIONAL PRINCIPLES

Background. The relevance of the study is due to the growing prevalence of ophthalmic pathology among children, in particular, the growing prevalence of refractive errors in early and older adolescence. The results of scientific research prove the presence of a direct correlation between the growth of the prevalence of ophthalmic pathology and the growth of the child's age and the amount of visual stress, which is primarily related to the educational process during school education. The effective organization of medical care should take into account modern medical and preventive technologies of early preventive intervention, as well as be comprehensive with the involvement of medical specialists (pediatric ophthalmologists, family doctors) and educators, family members, parents of the child for effective support and leveling of managed risk factors for the development of ophthalmic pathology.
 Aim: to study the modern organizational principles of preserving the health of eye care of children, to clarify the medical and social aspects of the formation of the burden of ophthalmic pathology from childhood in different countries of the world.
 Materials and methods. The materials for the research were publications of the results of modern scientific research on the study of medical and social aspects of preserving the ophthalmic health of children, the peculiarities of the organization of providing medical and preventive care to children with visual impairments. The methods for carrying out scientific research were: system approach and system analysis, as well as content analysis.
 Results of the study prove the prospects for the implementation of medical and preventive strategies in the provision of primary and specialized ophthalmic medical care, in view of the significant medical and social burden of ophthalmopathology, the distribution of nosologies by class of diseases of the eye and its accessory apparatus, which are most often found in certain age groups of the children's population, is presented. It has been proven that compliance with the optimal periodicity of medical and preventive examinations is necessary for the majority of ophthalmological nosologies diagnosed since childhood and involves long-term supervision. In children of preschool, preschool and early school age, efforts at early prevention and diagnosis of such ophthalmological nosologies as: refraction anomalies (astigmatism, hypermetropia, myopia) are justified. strabismus and amblyopia; accommodation disorders; lack of convergence. Untreated or untimely detected refraction anomaly, strabismus, amblyopia can lead to the development of irreversible loss of visual functions, blindness and even inhibition of the formation of the visual system with distorted perception of visual information, which without timely correction lead to the appearance of complications, progression of strabismus, decrease in visual acuity, amblyopia , asthenopia, headache and deterioration of general well-being.
 Conclusion. The important medico-social importance of disorders of visual functions in childhood is a serious problem for the health care system, public health and ophthalmology service, in particular. Reasoned expediency of applying measures to level the managed risk factors against the background of intersectoral interaction of doctors, educators, the child himself and his family. This approach allows you to prevent the negative impact of ophthalmic pathology on academic performance, activate physical development, and promote harmonious personality development.

The compliance of specialized medical care of patients with glaucoma to clinical recommendations (CR 96/1 “Primary open-angle glaucoma”) in Russian Federation regions

The high prevalence of primary open-angle glaucoma, its leading role in the structure of visual disability, and insufficient effectiveness of treatment, prevention and rehabilitation measures require new approaches to providing quality care of patients with glaucoma. It is important to analyze the epidemiological situation, human and technological resources in various regions of the Russian Federation. The paper evaluates the compliance of specialized medical care of patients with glaucoma with the approved clinical guidelines CR 96 “Primary open-angle glaucoma” in the regions of the Russian Federation monitored by the Helmholtz National Research Center for Eye Diseases, based on the material of on-site data collection visits. The epidemiological situation relating to glaucoma, the structure and performance indicators of ophthalmological service departments, preventive measures, human and material resources, and the correctness of statistical accounting and reporting were studied. In most regions, the times of examination and treatment correspond to the regional territorial programs covered by state guarantees. The cases when primary specialized care lags behind is associated with staff shortage at the outpatient level. Practically in all regions of the Russian Federation, diagnostic methods and conservative/surgical treatment techniques with proven high efficiency conform to CR 96/1 “Primary open-angle glaucoma”. Some of the regions, however, are insufficiently equipped for early diagnosis of glaucoma and monitoring its course.

Assessment of ocular hygiene and compliance among contact lens users during COVID-19 pandemic

The aim of the study is to assess the knowledge, attitude and practice of contact lens users among medical students and professionals in a tertiary hospital regarding eye hygiene and access to Ophthalmological medical services in the pandemic.After obtaining consent, a Questionnaire-based, cross-sectional study was conducted for a period of 2 months among 102 candidates including medical professionals and students in a tertiary hospital using Contact lenses. Chi-square statistics was used to analyze categorical variables, considering p-value<0.05 as statistically significant.83 users (81.37%) reported that their contact lens usage has reduced particularly during the pandemic, of whom 55 users (66.26%) stated to have had a fear of being more susceptible to COVID-19’. A significant number of users (n=35; p value=0.0015) even consider that it is necessary for contact lens users to switch to spectacles. A significant number of users (42 users; 41.18%) have confessed to touching their faces and eyes without proper hand washing. Only 16 participants (15.69%) were aware of the guidelines for contact lens usage and only 30 users (29.41%) availed tele-health services.The existence of poor Contact lens compliance amongst users as reflected by this study and many alike highlights the responsibility of Ophthalmologists to make sure that proper practices are maintained by increasing awareness among the public by addressing their fears and explaining the detrimental effects of unhygienic contact lens usage.

Impact of COVID-19 on ophthalmic surgical procedures in sub-Saharan Africa: a multicentre study

BackgroundThe COVID-19 pandemic had a profound impact on healthcare and ophthalmology services globally. Numerous studies amongst various medical and surgical specialties showed a reduction in patient attendance and surgical procedures performed. Prior published ophthalmic literature focused on specific types of procedures and were usually single centre. The current study attempts to quantify the impact on a larger scale, namely that of sub-Saharan Africa, and to include all ophthalmic subspecialties.MethodsThis is a retrospective analysis of the surgical records from 17 ophthalmology centres in seven countries located in East, Central, West and Southern Africa. The date of declaration of the first lockdown was used as the beginning of the pandemic and the pivot point to compare theatre records one year prior to the pandemic and the first year of the pandemic. We examined the total number of surgical procedures over the two year period and categorized them according to ophthalmic subspecialty and type of procedure performed. We then compared the pre-pandemic and pandemic surgical numbers over the two year period.ResultsThere were 26,357 ophthalmic surgical procedures performed with a significant decrease in the first year of the pandemic (n = 8942) compared to the year prior to the pandemic (n = 17,415). The number of surgical procedures performed was lower in the first year of the pandemic compared to the year prior to the pandemic by 49% [Incidence rate ratio (IRR) 0.51, 95% CI 0.41–0.64), 27% (0.73, 0.55–0.99), 46% (0.54, 0.30–0.99), 40% (0.60, 0.39–0.92) and 59% (0.41, 0.29–0.57) in sub-Saharan Africa (4 regions combined), West, Central, East and Southern Africa, respectively]. The number of surgical procedures in the different sub-specialty categories in sub-Saharan Africa (4 regions combined) was significantly lower in the first year of the pandemic compared to the year prior to the pandemic, except for glaucoma (IRR 0.72, 95% CI 0.52–1.01), oncology (0.71, 0.48–1.05), trauma (0.90, 0.63–1.28) and vitreoretinal (0.67, 0.42–1.08) categories.ConclusionThis study provides insight into the impact of the COVID-19 pandemic in multiple regions and countries on the African continent. The identification of which surgical subspecialty was most affected by the COVID-19 pandemic in each region allows for better planning and resource allocation to address these backlogs.

Pseudomonas Keratitis Predominance in Government Hospitals in Johor, Malaysia

Introduction: Keratitis is an eye-threatening condition, which requires immediate treatment, due to the rapid progression when the infection caused by Pseudomonas aeruginosa. This study aimed to describe the socio-demographic factors and risk factors related to Pseudomonas keratitis in selected six government hospitals in Johor, Malaysia. Methods: An 18 months cross-sectional study was conducted among bacterial keratitis patients from six government hospitals offering ophthalmology services in Johor, Malaysia. The cases were confirmed through a positive culture of Pseudomonas aeruginosa. All data on socio-demographic factors, risk factors, and symptoms were recorded using a data collection form and analysed using the Statistical Package for Social Sciences (SPSS) software version 26. Results: Fifty-five patients were diagnosed with Pseudomonas keratitis in this study. The majority of patients were males (65.5%) with a mean age of 41.22 years old. The majority of patients were of Malay ethnicity (60.0%). More than a quarter of cases are involved in office-oriented jobs (n=14, 25.5%). The major risk factors in this study were contact-lens usage (n=25, 45.5%), trauma (n=20, 36.4%), ophthalmic steroid usage (n=16, 29.1%), ocular surface disease (n=12, 21.8%) and previous eye surgery (n=4, 7.3%). This study found underlying medical illness (p=0.036) and ocular surface disease (p=0.051) are significantly associated with Pseudomonas keratitis. Conclusion: The present study is the first study in Malaysia focusing on Pseudomonas keratitis. This study provides additional information on the epidemiology data of keratitis in Malaysia. Future studies shall be extended to all government hospitals in Malaysia to obtain better insight on the disease burden of keratitis especially on Pseudomonas keratitis.

Ophthalmology Encounters During the COVID-19 Pandemic in a Student Run Free Clinic

Background: Ophthalmology services at student run free clinics (SRFC) serve an important role for the socioeconomically underserved within a city. The coronavirus disease 2019 (COVID-19) pandemic has worsened gaps in care for ophthalmology tertiary clinics, but its effects on ophthalmology encounters at SRFCs are not known.
 Methods: This was a retrospective chart review from a single center that compared patient encounters in the ophthalmology SRFC six months prior to its closure (pre-COVID group) with patient encounters in the ophthalmology SRFC six months after its reopening (post-COVID closure group).
 Results: There was a decline (47.3%) in the number of encounters in the post-COVID closure group (n=20) when compared to the pre-COVID group (n=38). While the number of encounters for routine screening stayed about the same in both groups, there was a 90.5% decline in encounters with active disease (21 pre-COVID vs. 2 post-COVID closure). Sub-group analysis of the pre-COVID group showed that patients with active disease tended to have worse vision (-0.33 logMAR, p=0.034 OD; -0.27 logMAR, p=0.048 OS) than those undergoing routine screening.
 Conclusions: Patients in West Texas with active eye diseases are not presenting to SRFC after its reopening. Early recognition of this is critical to address the potential gap in care in a vulnerable population.

Development of the AI Pipeline for Corneal Opacity Detection.

Ophthalmological services face global inadequacies, especially in low- and middle-income countries, which are marked by a shortage of practitioners and equipment. This study employed a portable slit lamp microscope with video capabilities and cloud storage for more equitable global diagnostic resource distribution. To enhance accessibility and quality of care, this study targets corneal opacity, which is a global cause of blindness. This study has two purposes. The first is to detect corneal opacity from videos in which the anterior segment of the eye is captured. The other is to develop an AI pipeline to detect corneal opacities. First, we extracted image frames from videos and processed them using a convolutional neural network (CNN) model. Second, we manually annotated the images to extract only the corneal margins, adjusted the contrast with CLAHE, and processed them using the CNN model. Finally, we performed semantic segmentation of the cornea using annotated data. The results showed an accuracy of 0.8 for image frames and 0.96 for corneal margins. Dice and IoU achieved a score of 0.94 for semantic segmentation of the corneal margins. Although corneal opacity detection from video frames seemed challenging in the early stages of this study, manual annotation, corneal extraction, and CLAHE contrast adjustment significantly improved accuracy. The incorporation of manual annotation into the AI pipeline, through semantic segmentation, facilitated high accuracy in detecting corneal opacity.

Mental healthcare access among US adults with vision impairment and depression and/or anxiety symptoms

BackgroundAlthough individuals with vision impairment are at greater risk for depression and anxiety, there has been limited study of mental healthcare utilization among this population. ObjectivesTo address this gap, this pooled cross-sectional study estimates the prevalence of mental healthcare utilization among individuals with vision impairment during the COVID-19 pandemic. MethodsWe calculated adjusted relative risk ratios and 95% confidence intervals of depression and/or anxiety symptoms and mental healthcare utilization using multinomial logistic regression, accounting for demographics, social determinants of health, and survey week. The population-based, U.S. Census Bureau Household Pulse Survey was administered April 2021–March 2022. Participants included 800,935 US adults (weighted population: 174,598,530) ResultsAdjusting for other factors, adults with vision impairment were more likely to report depression symptoms (RRR: 2.33; 95% CI: 2.03–2.68), anxiety symptoms (RRR: 2.12; 95% CI: 1.94–2.33, and comorbid depression and anxiety symptoms (RRR: 3.77; 95% CI: 3.51–4.04) compared with individuals with no vision impairment. Among individuals reporting anxiety or depression symptoms, individuals with vision impairment (RRR: 1.46; 95% CI: 1.35–1.59) were more likely to lack of mental healthcare utilization compared with individuals with no vision impairment. ConclusionFindings suggest that individuals with vision impairment are at increased risk for depression and/or anxiety symptoms and report reduced mental healthcare utilization compared with individuals without vision impairment. Additional programs and policies are needed to improve mental healthcare utilization among individuals with vision impairment and depression and/or anxiety symptoms, such as increased telehealth accessibility and coordination of behavioral health and ophthalmology services.

Trends in Medicare Submitted Charges to Allowed Payment Ratios for Ophthalmology Services.

Many physicians charge more than the Medicare insurance program pays. Current charge-to-payment ratios in ophthalmology and trends over the years are unknown. In this work, we examined physician charge-to-payment ratios in ophthalmology across procedures and consultations. We utilized data from 100% final-action physician/supplier Part B Medicare fee-for-service (FFS) population from 2015 to 2020. We retrieved data on ophthalmic procedures and consultations, both facility-based and non-facility-based, conducted by ≥ 50 ophthalmologists. We analyzed median charge-to-payment ratios, which were calculated as submitted charges divided by the Medicare-allowed payments, between ophthalmic procedures and consultations to assess for trends over the study period. We find that the median charge-to-payment ratio for all current procedural terminology (CPT) codes in 2020 was 2.23 (Interquartile range (IQR): 1.54-3.27) as compared to 2.00 (IQR: 1.39-2.92) in 2015, an overall 2.76% average annual growth rate from 2015-2020. For ophthalmic procedures, the median charge-to-payment ratio in 2020 was 3.03 (IQR: 2.13-4.41) compared to 2.79 (IQR: 1.96-3.97) in 2015, corresponding to a 2.01% AAGR from 2015-2020. For consultations, those rates were 2.06 (IQR: 1.48-2.96), 1.85 (IQR: 1.33-2.59), and 2.71%, respectively. We found that the submitted charge-to-Medicare payment ratios among ophthalmic procedures and consultations have steadily increased since 2015. However, there was a relatively low rate of excess charges for ophthalmology services compared to other surgical-based specialties with minimal variation among providers.

Ocular Chemical Burns: Epidemiological Trends in a Colombian Medical Center.

Ocular chemical burns are a significant cause of visual impairment. This study aims to characterize the ocular chemical burns in a southwestern Colombia referral center and identify associated factors with low vision. A retrospective cohort study was carried out based on the review of medical records of patients diagnosed with chemical eye burns who consulted the emergency ophthalmology service between January 2016 and December 2019. Descriptive statistics were performed. Associations with low vision (Best-Corrected Visual Acuity, ≥20/70 in Snellen chart) in the last follow-up appointment were identified using a multivariate logistic regression with odds ratios (OR) and 95% confidence intervals (95% CI). About 219 eyes affected by chemical burns were identified from 174 patients with a mean age of 39 years (SD ± 20), of which 57.5% (n = 100) were men. We ran a multivariate model adjusted by sex, eye wash, type of chemical, and Dua's classification. We found that the odds of low vision for patients without eyewash before the consult were 3 times the odds of those who had it (adjusted OR [aOR] = 3.5, 95% CI = 1.3-9.4) and almost 5 times for those with Dua's classification >1 (aOR = 4.7, 95% CI = 1.7-12.9). The ocular chemical burns reported in this study occurred more in young people of productive age. Acids were the principal causal agent. The association between lack of early management and the severity of the chemical burn with low vision has been highlighted. Ocular burns remain a relevant cause of consultation on the ophthalmology service in Cali, and prevention strategies are required.

Promoting eye health in public school children: an experience report

Eye health is essential for a good quality of life. In this sense, it is feasible to diagnose possible alterations that can occur from birth and to observe vision failures in children's daily activities, such as during lessons at school. The aim of this research is to report on the experience of nursing students in promoting eye health among children in the public school system in the municipality of Parnaíba-PI. This is a descriptive, exploratory study of the experience report type, with a qualitative approach and referring to a university extension project called "Small Visions". In addition, 379 children between the ages of 6 and 12 were tested and 81 were referred to the ophthalmology service. Thus, the children benefited from the application of the Snellen optometric test and the academics gained a differentiated clinical view of the subject.

Assessment of the quality of the ophthalmological Service at the Hospital of the State Public Servant of São Paulo based on the number of ombudsman cases

This study aims to highlight improvements in the quality indicators of ophthalmology services provided by the Hospital do Servidor Público Estadual de São Paulo, resulting from a significant change in the organization of the cataract surgery queue. The transition from an obsolete and inflexible system, represented by an outdated spreadsheet, to a dynamic virtual queue system had a positive impact on the operationalization of services. This research analyzes the reduction in both absolute and proportional complaints received through ombudsman channels, specifically related to cataracts, and the reduction in waiting time for surgery, emphasizing that most surgeries are now performed within the timeframe established by medical literature. Furthermore, it investigates the impact of ombudsman services on the evaluation of service quality, relying on relevant scientific evidence.