Optometry Service Research Articles

Improving eye care quality through brief verbal intervention on optometry service provider by using unannounced standardized patient with refractive error: study protocol for a randomized controlled trial

BackgroundImproper refractive correction can be harmful to eye health, aggravating the burden of vision impairment. During most optometry clinical consultations, practitioner-patient interactions play a key role. Maybe it is feasible for patients themselves to do something to get high-quality optometry. But the present empirical research on the quality improvement of eye care needs to be strengthened. The study aims to test the effect of the brief verbal intervention (BVI) through patients on the quality of optometry service.MethodsThis study will take unannounced standardized patient (USP) with refractive error as the core research tool, both in measurement and intervention. The USP case and the checklist will be developed through a standard protocol and assessed for validity and reliability before its full use. USP will be trained to provide standardized responses during optical visits and receive baseline refraction by the skilled study optometrist who will be recruited within each site. A multi-arm parallel-group randomized trial will be used, with one common control and three intervention groups. The study will be performed in four cities, Guangzhou and three cities in Inner Mongolia, China. A total of 480 optometry service providers (OSPs) will be stratified and randomly selected and divided into four groups. The common control group will receive USP usual visits (without intervention), and three intervention groups will separately receive USP visits with three kinds of BVI on the patient side. A detailed outcome evaluation will include the optometry accuracy, optometry process, patient satisfaction, cost information and service time. Descriptive analysis will be performed for the survey results, and the difference in outcomes between interventions and control providers will be compared and statistically tested using generalized linear models (GLMs).DiscussionThis research will help policymakers understand the current situation and influencing factors of refractive error care quality, and then implement precise policies; at the same time, explore short and easy interventions for patients to improve the quality of optometry service.Trial registrationChinese Clinical Trial Registry ChiCTR2200062819. Registered on August 19, 2022.

Changes in utilisation of optometry services with a non-targeted publicly-funded health care voucher system

ABSTRACT Clinical relevance Understanding the impact of a health care voucher scheme and service access barriers could facilitate optometry service promotion to the older population. Background A voucher is one strategy to improve the utilisation of the different health care services available in the private sector. This study aims to explore how a health care voucher system for older people impacts utilisation of optometry services from the perspective of service users and service providers. Methods People aged 65 years or above were recruited to fill in a structured questionnaire studying the usage characteristics and access barriers of optometry services and the health care voucher. Views from the optometrists about the voucher scheme were collected by questionnaire. Results A total of 1156 valid questionnaires from eligible voucher users was collected. Results showed that 53.7% (621/1156) of participants had used optometry services within the past 2 years. Lack of familiarity with services provided, professional fees, and prices of spectacles were the main barriers to using optometry services. Of those participants who had used the voucher for optometry services previously, 80.4% (284/353) had an eye examination in the past 2 years. Among 389 optometrists who participated in the study, over 80% agreed that the voucher scheme improved awareness of major eye conditions and access to prescription spectacles when necessary. Conclusion The health care voucher for older people improved access to optometry services. Access could be further improved by increasing price transparency of professional services and prescription spectacles. Responses from optometry service providers supported the view that the voucher scheme improved access to, and utilisation of, preventive care services.

Optometry independent prescribing during COVID lockdown in Wales

IntroductionDuring the COVID‐19 lockdown, primary care optometry services in Wales moved to a hub model of provision. Three independent prescribing models were available in different areas: a commissioned Independent Prescribing Optometry Service (IPOS), independent prescribers that were not commissioned and no independent prescribers available. This allowed a unique opportunity for comparison.MethodOptometry practices completed an online survey for each patient episode. Analysis of the data gave insight into patient presentation to urgent eye services and the drugs prescribed by optometrists. Medicines prescribed, sold or given and onward referral were compared between areas with an IPOS service (n = 2), those with prescribers but no commissioned service (n = 2) and those with no prescribers (n = 2).ResultsData from 22,434 reported patient episodes from 81 optometry practices in six health boards between 14 April 2020 and 30 June 2020 were analysed. Urgent care accounted for 10,997 (49.02%) first appointments and 1777 (7.92%) follow‐ups. Most (18,006, 80.26%) patients self‐referred. The most common presenting symptom was ‘Eye pain/discomfort’ (4818, 43.81% of urgent attendances). Anterior segment pathology was the most reported finding at first (6078, 55.27%) and follow‐up (1316, 74.06%) urgent care appointments. Topical steroids (373, 25.99% of prescriptions) were the most prescribed medications. More medications were prescribed in areas with an IPOS service (1136, 79.16% of prescriptions) than areas with prescribers but no commissioned service. There were more follow‐up appointments in optometric practice and fewer urgent referrals to ophthalmology in IPOS areas.ConclusionUrgent care services were most utilised by patients with discomfort caused by anterior eye conditions. IPOS services enabled optometrists to manage conditions to resolution without referral and without reduction in medications sold or given. Commissioners should recognise the value in reducing burden in urgent ophthalmology and the need for follow‐up as part of a commissioned independent prescribing service.

A Reactivation of Ocular Toxoplasmosis during Pregnancy

Background: Toxoplasma gondii is a parasite estimated to affect over 500 million people worldwide. The feline is the definitive host for the parasite and infection may be acquired or congenital via maternal transmission. Humans may acquire the infection by ingestion of raw or undercooked meats and vegetables, contaminated water, or exposure to infected cat feces. The infection is often benign, self-limiting, and asymptomatic for humans, but potentially life threatening to infants or the immunocompromised patient. Case Report: A 22 year-old Caucasian female, pregnant at 12 weeks gestation, presented to the optometry service with acute symptoms of hazy vision and a new gray stationary blind-spot in the inferior field of vision of the right eye. Clinical picture led to diagnosis of reactivated ocular toxoplasmosis. Conclusion: Ocular toxoplasmosis primarily affects the retina, producing a retinochoroiditis with resultant scarring and potential blindness. Treatment with a combination of antibiotics and steroid may be required. Allergy history and current pregnancy were important factors to consider when determining treatment of our patient.

Eye health profile of affordable eye care service users

ABSTRACT Clinical relevance Knowledge of the typical eye health profile of patients experiencing social or economic disadvantage is useful for health care modelling. Background The aim of this work is to profile the ocular health and sociodemographic characteristics of Australian College of Optometry service users of all ages and to explore the relationships between key sociodemographic characteristics and eye health. Methods For 3093 eye examinations, best-corrected distance visual acuity and mean spherical equivalent refractive error were tested non-parametrically by clinic category, remoteness area, number of co-morbidities, gender and indigenous status, also correlated against age and socioeconomic advantage/disadvantage. Covariates of interest were entered into linear mixed models of visual acuity and mean spherical equivalent refractive error, controlling for age. Risk estimates are reported for visual impairment (defined as ≤6/12 best-corrected distance visual acuity in one or both eyes) and ocular diagnoses. Results Visual impairment is more prevalent amongst service users examined in domiciliary settings. Increasing co-morbidities were associated with poorer best-corrected distance visual acuity. Aboriginal and Torres Strait Islander service users had lower visual impairment prevalence overall but proportionally fewer aged ≥50 years attended for eye care, compared to non-indigenous. Conclusions Domiciliary eye examinations detect remediable visual impairment. Federal public health interventions delivered by the Australian College of Optometry for Aboriginal and Torres Strait Islander eye care appear effective but may not reach all aged ≥ 50 years; further research is required. Identification of multiple co-morbidities should prompt optometrists to tailor public health messages and signpost to low vision services earlier.

Observations on Optometry in the Veteran's Administration from an Optometric Educator's Perspective

This invited address was presented at the 42nd Annual Meeting of the National Association of Veteran’s Administration Optometrists (NAVAO), Thursday, October 24, 2019, Hyatt Regency Hotel, Orlando, FL. This paper discusses medicine, dentistry, and optometry’s entry into the Veteran’s Administrations System as well as optometry’s many challenges to become an Optometry Service. It also reviews the many challenges the profession has faced as it has endeavored to increase the number of VA optometry staff positions and the educational experience of optometry students, residents and fellows in providing eye care for America’s veterans.

Gender and ethnic differences in pterygium prevalence: an audit of remote Australian clinics

ABSTRACT Clinical relevance Developing an accurate picture of the demographic profile and refractive status of Aboriginal and non‐Aboriginal individuals with pterygium will facilitate health planning and appropriate deployment of health‐care resources in rural Australia. Background To date, there is a paucity of reports in the literature regarding Aboriginal ocular health and refractive error. This study examines clinical data from a rural ophthalmology outreach clinic – a predominantly Aboriginal population. Methods An assessment was undertaken of data of 293 patients noted to have pterygium present in at least one eye, from a sample of 2,072 individuals seen in rural northern Western Australia in 2017 by the Lions Outback Vision Visiting Optometry Service. Results Pterygium was found in 14.1 per cent (n = 293) of patients using the Lions Outback Vision service. The mean age of those with pterygium (n = 293) was 57.1 ± 11.9-years (mean ± standard deviation); 188 were female (64.1 per cent); 260 identified as Aboriginal (88.7 per cent), 22 identified as non‐Aboriginal (7.5 per cent) and 11 did not specify (3.8 per cent). There were more males than females with pterygium in the non‐Aboriginal group (18.0 per cent versus 6.4 per cent); however, the reverse was true in the Aboriginal group (11.7 per cent versus 17.0 per cent). Analysis of the subjective refractive data in those with pterygium revealed an overall mean spherical equivalent value of +0.66 ± 1.28 DS. The median (interquartile range) best‐corrected visual acuity was 0.0 (−0.1 to 0.0) logMAR (6/6 Snellen equivalent). Conclusions This paper increases our knowledge of ocular health in a remote Australian population, with an emphasis on the differences between Aboriginal and non‐Aboriginal individuals, males and females.

Final Visual Outcomes and Treatment Received for Children Referred from a UK Primary School Visual Screening Program: A Comparison of An Orthoptic-led Program with Orthoptic-delivered Services

ABSTRACTThere is little published evidence relating to the final visual acuity of children who are identified as having reduced vision at a school screening program. The school vision screening program in Leeds (led by an orthoptist but delivered by health care support workers within the school nursing team) is examined.Results: 7807 children were screened in school between November 1, 2013, and September 1, 2014. Of these, 319 (4%) failed the screen and were referred to the general optometry service and 547 (7%) were referred to the Children’s Community Eye Service (CCES). Of the children who were referred to the CCES, 79.4% attended their first appointment and 86.4% were positive referrals. Of the children with reduced vision, 31 (8.3%) were found to have a manifest strabismus or eye movement disorder; 75 (20% of the positive referrals) required occlusion therapy for amblyopia; 52.6% of those with initially reduced vision obtained good visual acuity following spectacle correction alone within an 18- to 24-week refractive adaptation period. Of those who completed their treatment, 92.9% had vision within normal limits for their age in both eyes at discharge. Of children referred from vision screening who were found to have a defect, 64.6% had that treatment completed within three visits.Conclusion: Vision screening identifies individuals with treatable vision defects who have a greater than 90% chance of achieving normal visual acuity with good compliance to treatment. Vision screening programs led by an orthoptist but delivered by well-trained and monitored screeners can be of as good quality as a screening program delivered by orthoptists.

Visual health awareness, the Scottish community optometry service and Eyecare Integration Project: Breaking barriers in preventing visual impairment

There are 34,492 registered with severe or partial sight impairment in Scotland, with 75% aged over 65. With the ageing population, the proportion of those who will develop sight impairing disease will only increase. Therefore, early presentation and treatment are important. Recently, new sight saving treatments and community screening programmes for sight impairing disease have been introduced with concomitant advance in ophthalmic digital imaging. In order to assess older patients’ attendance of free eye tests, awareness of different sight impairing disease and treatments. We describe the first electronic visual healthcare system within any global public healthcare service – ‘The Scottish Eyecare Integration Project’ – and potential improvements along with the General Ophthalmic Service (GOS) contract. A 14-point questionnaire was devised to assess 100 patients’ awareness of free annual eye tests, and the three most common causes and treatment for severe sight impairment: age-related macular degeneration (ARMD), glaucoma, and diabetic retinopathy (DR). In all, 82% of patients were aware of the free annual eye tests; however, 31% had not attended community optometrist for over 2 years. There was good awareness of glaucoma (77%), but poor understanding of glaucoma treatment (24%), ARMD (43%) and ARMD treatment (17%). Only 39% of patients had heard of free annual DR screening, but there was a significant difference between the two groups ( p = .0263), with increased awareness in the middle-aged group. More education is required to encourage the older population to use existing and new eye services. The Scottish Eyecare Integration Project along with the GOS contract is a significant step of change towards meeting the demand for a multidisciplinary approach, bringing ophthalmic care closer to home and into the community.

Detainee Optometry at Camp Cropper, Iraq, 2009–2010

This article details the first in-depth analysis of an Optometry Service working with a large Middle Eastern detainee population composed entirely of Iraqi males. The mission of the Camp Cropper Optometry Service was to provide eye care services to the detainee population consistent with the standards of optometric care that would be provided to any U.S. military member in the same geographic area. This included providing detainees with eyeglasses, therapeutic treatment of eye disease, and referral for treatment of medical conditions and surgical care, if it was needed and available at the U.S. military facilities in the Iraq Theater. Diagnoses, services provided, and medications given to the detainees are listed in detail and demonstrate the complexity of pathology encountered in this population.

Diabetes processes of care in the Australian veteran population

Objective To determine the proportion of veterans with diabetes who had claims for recommended processes of diabetes care in 2005. Design Observational study of 19,810 veterans’ dispensed medicines indicative of diabetes. Claims to the Department of Veterans’ Affairs for HbA 1c, microalbuminuria, ophthalmology or optometry services, podiatry services, diabetes care plans, medication reviews, case conferences and GP management plans were assessed. Results Overall 63% had at least one HbA 1c claim in the year under review, while 40% had a microalbuminuria claim. The majority (87%) had a claim for an ophthalmology or optometry service, while two-thirds had a podiatry service claim. Only one-fifth had claims for an annual diabetes care plan. Just under half had a claim for any type of care plan, including medication review, discharge plan, case conference, GP management plan or health care plan. Veterans resident in aged-care facilities were significantly less likely to have claims for any of these services apart from medication review. Conclusions While administrative claims data may under-represent some processes of care carried out routinely in general practice, this study suggests under-utilisation of services for veterans with diabetes, particularly those resident in aged-care facilities.

Optometry research. Part 1: Funding sources.

Part 1 of this report presents an overview of U.S. ophthalmic research in general and of optometry research in particular and identifies the National Eye Institute (NEI) as the dominant funder of both types of research. Part 2 examines how NEI funding has been distributed among the U.S. schools and colleges of optometry in the past, whereas Part 3 examines the production of published research from the schools and colleges and the Department of Veterans Affairs Optometry Service. Information is presented to indicate that the schools of optometry account for about 3% of all NEI funding and produce about 3% of all published ophthalmic research. Published optometry research results mainly from the activities of four schools and the VA Optometry Service, which has rapidly become the leading source of articles published in The Journal of the American Optometric Association and presenter of continuing education at the Academy's annual Ellerbrock Lectures. This study suggests optometry needs to husband its relatively small research base and, in the author's opinion, concentrate on the support of clinical trials and research directly relevant to primary eye care rather than basic biologic or physiologic research.

THE FORT DIX REPORT--A LONGITUDINAL STUDY OF THE EFFECTS OF CONTACT LENSES.

Walson Army Hospital Fort Dix, New Jersey *Read before the annual meeting of the American Academy of Optometry, Section on Contact Lenses and Subnormal Vision Aids, Columbus, Ohio, December 15, 1964. For publication in the March, 1965, issue of the American Journal of Optometry and Archives of American Academy of Optometry. †Optometrist. Captain, Medical Service Corps, Chief, Optometry Service, Department of Surgery. Fellow, American Academy of Optometry. This material has been received by the Office of The Surgeon General, Department of the Army, and there is no objection to its presentation and/or publication. This review does not imply any indorsement of the opinions advanced or any recommendation of such products as may be named.