Pediatric Eye Care Research Articles

Parents' or Guardians' Knowledge, Attitudes and Practices in the Prevention and Management of Childhood Myopia.

The aim of this study was to assess the knowledge, attitude, and practices (KAP) of parents or guardians regarding the prevention and management of childhood myopia. This cross-sectional study was conducted at the Department of Ophthalmology in the First Affiliated Hospital of Soochow University (Suzhou, China) between August 2023 and November 2023. Parents or guardians who willingly volunteered to take part in the study were surveyed using a self-designed questionnaire. A total of 571 participants returned valid questionnaires, among whom 288 respondents (50.44%) fell within the 31- to 40-year age group and 474 respondents (83.01%) were identified as myopic. The mean KAP scores for the knowledge, attitude and practices dimensions were 23.34 ± 3.05 (possible range: 0-26), 46.47 ± 4.02 (possible range: 12-60), and 40.52 ± 7.07 (possible range: 11-54), respectively. Structural equation modeling analysis indicated that education had a direct effect on knowledge (estimate = 0.41, P = 0.038), while knowledge directly influenced both attitude (estimate = 0.40, P < 0.001) and practices (estimate = 0.36, P < 0.001). Also, attitude was found to have a direct impact on practices (estimate = 0.45, P < 0.001). Parents or guardians had adequate knowledge, a positive attitude, and proactive practices towards the prevention and management of childhood myopia, which might be affected by their educational level. This comprehensive understanding of parental perspectives highlights the potential for targeted interventions in clinical settings to further enhance pediatric eye care.

Potential Gaps in Eye Care Based on Evaluation of Federally Qualified Health Centers

Federally qualified health centers (FQHCs) are federally funded community health clinics that provide comprehensive care to underserved populations, making them potential opportunities to offer eye care and address unmet health care needs. Evaluating the presence of eye care services at FQHCs in Florida is important in understanding and addressing possible gaps in care for the state's large uninsured and underserved populations. To determine whether FQHCs in Florida are currently offering eye care services, where they are available, what services are being offered, and who provides them. This study used a cross-sectional design conducted within 1 year (from November 2023 to February 2024). FQHCs listed in the US Health Resources and Services Administration database were contacted by telephone to inquire about the presence of eye care services. The FQHCs were located in both urban and rural areas in Florida to assess accessibility of eye care services in the state. School-based health centers and nonophthalmic specialty care health centers were excluded. A total of 437 FQHCs were included. Primary outcomes included the presence of eye care services, types of services offered, clinician type (optometrists or ophthalmologists), frequency of services, and availability of pediatric services. Among 437 FQHCs contacted, only 39 (8.9%) reported offering eye care services. These services primarily included vision examinations, glasses prescriptions, and dilated eye examinations. Optometrists were the primary providers of services at all clinics, with no clinics reporting care by ophthalmologists. The frequency of services varied considerably, ranging from daily to bimonthly. Thirty-seven (94.9%) of the 39 clinics offered pediatric eye care services. The low prevalence of FQHCs with eye care services and the absence of ophthalmologist-provided care highlight a gap in access to eye care for underserved populations in Florida. These findings support investigations into implementing eye care services and interventions at FQHCs that might enhance access and equity in eye care.

Myopic Shift over 5 Years after Pediatric Lensectomy with Primary Intraocular Lens Implantation

To report the change in refractive error over 5 years following primary intraocular lens (IOL) placement by age at surgery, and to identify factors associated with the change in refractive error after 5 years. Prospective observational study at 61 pediatric eye care practices. 186 eyes of 152 children undergoing primary IOL implantation before 13 years of age for non-traumatic cataract. Cataract surgery with primary IOL placement MAIN OUTCOME MEASURES: Five-year change in refractive error (spherical equivalent) by age at surgery (<1 year; 1 to <2.5 years; 2.5 to <4 years; 4 to <7 years; 7 to <13 years). Five-year myopic shift in children 4 to <13 years with immediate postoperative myopia vs emmetropia or hyperopia. Mean spherical equivalent myopic shift (95% confidence interval [CI]) was -5.99 D (-7.64 to -4.34) when surgery was performed at 0 to <1 year of age (n=13), -3.53 D (-4.57 to -2.48) at 1 to <2.5 years (n=28), -1.91 D (-2.55 to -1.26) at 2.5 to <4 years (n=36), -2.04 D (-2.60 to -1.49) at 4 to <7 years (n=60), and -0.83 D (-1.27 to -0.40) at 7 to <13 years (n=49) (P<.01 for each comparison with the oldest group). Variability of myopic shift also decreased with increasing age (P<.01). In eyes of children 4 to <13 years (small sample size precluded analysis of children <4 years), there was significantly less mean change [95% CI] in refractive error over 5 years in eyes with myopia immediately after surgery (-0.69, 95% CI -1.48 to +0.10) than eyes with emmetropia/hyperopia immediately after surgery (-1.70, 95% CI -2.10 to -1.31) (difference = -1.01 D, 95% CI -1.89 to -0.14 D, P=.03). In this large, prospective cohort study of children younger than 13 years of age undergoing cataract surgery with primary IOL placement, there was greater and more variable myopic shift in children undergoing surgery at a younger age. Our finding of less myopic shift over 5 years in eyes with unintended immediate postoperative myopia deserves further study to more accurately guide IOL power selection.

Eye Mobile Units and Their Effect on Access to Pediatric Eye Care

Eye Mobile Units and Their Effect on Access to Pediatric Eye Care

Disparities in Amblyopia Treatment Outcomes: The Impact of Sociodemographic Factors, Treatment Compliance, and Age of Diagnosis

ObjectiveTo identify clinical and sociodemographic factors associated with disparities in amblyopia treatment outcomes. DesignRetrospective chart review. SubjectsChildren ≤8 years old diagnosed and treated for unilateral refractive or strabismic amblyopia at our institution from 2012-2022. MethodsChildren with amblyopia were categorized by outcome: resolved amblyopia (<0.2 logMAR interocular difference [IOD] in visual acuity, or no fixation preference in non-verbal patients) or persistent amblyopia. Demographic and clinical data were recorded from the medical record. Zip codes were used to calculate Childhood Opportunity Index (COI) scores, estimated annual household income, and distance to hospital. Main Outcome MeasuresSociodemographic and clinical factors were compared between children with resolved and persistent amblyopia. Factors significant at p<0.10 on univariate analysis were included in a multivariable regression model. Results168 patients met inclusion criteria, and 131 (78%) had resolved amblyopia. Demographic factors associated with resolution of amblyopia were younger age at diagnosis (3.3±1.7 vs. 4.5±1.9 years, p=0.0009), English as the primary language (79.4% vs. 62.2%, p=0.04), higher estimated annual income ($83,315.93±29,276.64 vs. $71,623.00±26,842.56, p=0.03), higher COI scores (50.9±27.3 vs. 40.0±26.4, p=0.03), and living further from our institution (28.6±37.6 vs. 14.9±12.7 miles, p=0.003). Patients with resolved amblyopia also had higher rates of treatment compliance (83.2±25.0% vs. 75.6±24.4%, p=0.009) and shorter delays in follow-up (40.1±76.8 vs. 61.1±90.4 days, p=0.02). Amblyopia persistence was borderline associated with governmental insurance and higher presenting IOD in visual acuity (both p=0.06). On multivariate analysis, only younger age at amblyopia diagnosis (p=0.0010) remained significantly associated with amblyopia resolution. ConclusionsOur findings suggest that disparities in amblyopia outcomes are related to differences in age at diagnosis. Interventions to lower the age at which amblyopia is diagnosed, such as programs to improve vision screening rates and access to pediatric eye care in at-risk groups, may directly address inequities in rates of amblyopia resolution.

Childhood visual impairment causes and barriers to accessing eye care: A suggested approach for Africa.

Childhood vision impairment (VI) has a significantly harmful effect on both health and social outcomes. To assess the causes of childhood VI, to determine obstacles to accessing eye care services and to develop a strategy for the childhood eye care system in African nations. This systematic review was conducted by searching several online databases, including; Scopus, PubMed, ProQuest, Web of Science, Google Scholar, Ebsco and Medline. They focussed on articles available between 2003 and 2023. These studies were conducted to evaluate the causes of childhood VI and to assess obstacles to accessing eye care services in African countries. The main causes of childhood VI in African nations can be avoided with timely diagnosis and an appropriate management strategy. The leading obstacles to accessing childhood eye care services were a lack of availability, accessibility and affordability. In addition to these barriers, we found that there are concerns with quality of services, primary health care system, geographic barriers, incorrect health beliefs, inappropriate parental perception, a lack of knowledge, attitudes and inadequate practices related to paediatric eye care. The main causes of childhood VI were uncorrected refractive error (RE), amblyopia, cataract and corneal opacities that can be avoided with timely diagnosis and an appropriate management strategy. While the main obstacles to accessing childhood eye care services were a lack of availability, accessibility, affordability and healthcare system.Contribution:The recommended strategy for childhood eye-care services includes models for delivery and training.

Access to Pediatric Eye Care by Practitioner Type, Geographic Distribution, and US Population Demographics

Investigating disparities in service coverage of pediatric optometrists and pediatric ophthalmologists in relation to patient demographics will illuminate vulnerable populations and inform future interventions. To characterize the geographic distribution of pediatric eye care practitioners and analyze its association with population demographics. In this cross-sectional study, 4 public databases were used to identify the addresses of pediatric optometrists and pediatric ophthalmologists in the US in April 2023. Addresses were geocoded, and population demographic data were collected. Pediatric optometrists and pediatric ophthalmologists listed in the public databases, as well as respondents to the 2020 US census, were included in this study. Data were analyzed from April to July 2023. Public databases and US census data of eye practitioners and their practice locations. Geographic distribution of pediatric optometrists and pediatric ophthalmologists as listed in public databases and correlations between service coverage and US population demographics. A total of 586 pediatric optometrists (302 female [51.5%]) and 1060 pediatric ophthalmologists (590 male [55.7%]) were identified. Among US counties, 203 (6.5%) had at least 1 pediatric optometrist, and 308 (9.7%) had at least 1 pediatric ophthalmologist, showing substantial geographic overlap (odds ratio, 12.7; 95% CI, 9.4-17.4; P < .001). In the 2834 counties without pediatric ophthalmologists, 2731 (96.4%) lacked pediatric optometrists. There were more pediatric ophthalmologists per million people (3.3) compared with pediatric optometrists per million people (2.5) across all states (difference, 0.8; 95% CI, 0-1.9; P = .047). Among counties with practitioners, the median (IQR) number of pediatric optometrists per million people was 7.8 (0.4-245.0), surpassing the median (IQR) number of pediatric ophthalmologists per million people, 5.5 (1.0-117.0). Counties with pediatric ophthalmologists had higher mean (SD) household incomes than counties with pediatric optometrists ($76 126.87 [$21 879.23] vs $68 681.77 [$18 336.40]; difference, -$7445.10; 95% CI, $2519.51-$12 370.69; P = .003) and higher mean (SD) population with bachelor's degrees than counties with pediatric optometrists (79 016 [82 503] vs 23 076 [44 025]; difference, -55 940; 95% CI, -73 035 to -38 845; P < .001), whereas counties with neither specialist type had the lowest mean (SD) household income ($57 714.03 [$2731.00] vs $78 388.67 [$18 499.21]; difference, -$20 675.00; 95% CI, -$21 550.90 to -$19 799.10; P < .001) and mean (SD) population with bachelor's degrees (5113 [12 875] vs 167 015 [216 486]; difference, -161 902; 95% CI, -170 388.9 to -153 415.1; P < .001) compared with counties with practitioners. Geographic disparities in pediatric eye care access, compounded by socioeconomic differences, underscore the urgency of augmenting practitioner support in underserved areas.

Mapping the Pediatric Eye Care Deserts in the US—A Call for Action

Mapping the Pediatric Eye Care Deserts in the US—A Call for Action

Comparing paediatric optometric vision care in Canada over a 14-year period.

In Canada, teaching in paediatric eye care has increased in the past decade both within the optometry curriculum and as continuing education to optometrists. Paediatric vision care guidelines have also been established by North American optometric associations. This study examined whether this exposure was associated with changes in paediatric eye care in Canada over a 14-year period. Canadian optometrists were invited to participate in an anonymous 35-item survey in 2007 and 2021. The surveys sought to investigate optometrist's recommendations for first eye examinations, the number of paediatric patients seen in a typical week and preparedness to provide eye examinations to children. Response frequencies were determined for each survey item. Across Canada, 133/1000 (13.3%) and 261/~6419 (~4.1%) optometrists responded to the survey in 2007 and 2021, respectively. No significant difference was found in the number of years practicing, days per week in practice and total number of patients seen per week. The modal age optometrists recommended children be seen for their first eye examination changed from 3-4 years in 2007 (53%) to 6-12 months in 2021 (61%). In 2007, 87% of respondents provided eye examinations to children <2 years, increasing to 94% in 2021 (p = 0.02). Despite a reduction in the recommended age between the two survey years, the most frequent age children were seen for their first eye examination was 3-4 years (30% in both surveys) and the most common age seen in a typical week remained unchanged (4-6 years-56% 2007; 66% 2021). Although optometrists' willingness to provide paediatric eye care increased over the past 14 years, the number of children seen in a typical week did not change. Barriers to determine why more children are not being seen at an earlier age need to be investigated.

Review of the Disparities in Access to Pediatric Eye Care Among Low Socioeconomic Status and Underrepresented Racial Minority Groups Exacerbated by the Economic Downturn in Pediatric Ophthalmology.

To explore the association between race and socioeconomic status on health disparities in pediatric eye care, characterize the status of diversity within the pediatric ophthalmology workforce, and propose potential solutions to improve access to vision care, particularly for children from vulnerable populations. The major studies examining the socioeconomic and racial disparities in visual outcomes and the impact of diversity in the ophthalmology workforce were reviewed. Currently, the pediatric ophthalmology workforce has limited racial diversity, and increasing the number of underrepresented in medicine providers has potential to improve access to pediatric eye care, particularly for underserved populations. Mobile eye clinics, school-based vision programs, and health literacy initiatives may engage communities to bring eye care directly to children and enhance follow-up. Families with lower socioeconomic status may represent a vulnerable population facing significant access to pediatric eye care barriers, particularly for asymptomatic pediatric eye conditions. Emphasis on strategies that directly engage communities and bring free vision care to families should be given to improve disparities in visual health outcomes. Ophthalmologists and pediatric ophthalmologists should be aware of the current racial underrepresentation within the pediatric ophthalmology workforce, and the importance of workforce diversity in accelerating physician-patient concordance and access to eye care. [J Pediatr Ophthalmol Strabismus. 2024;61(3):172-178.].

Association of Sociodemographic Characteristics with Pediatric Vision Screening and Eye Care: An Analysis of the 2021 National Survey of Children's Health

ObjectiveVision screening and regular eye care can help to detect and treat potentially irreversible vision impairment. This study aims to investigate the associations between sociodemographic and health characteristics and the receipt of eye care among children aged 17 and under in the United States. DesignThis cross-sectional study used data from the National Survey of Children's Health, a nationally representative and population-based survey of randomly sampled households. ParticipantsParticipants were children aged 0 to 17 years old, residing in all 50 states and the District of Columbia, whose caregivers or parents answered an address-based survey by mail or online. MethodsWeighted prevalence calculations were applied to analyze the data, and logistic regression was performed to explore associations between reported eye care and demographic, health, and parent-related variables. Main outcomes and measuresCaregiver-reported vision screenings, referral to an eye doctor after vision screening, eye doctor visits, and prescription of corrective lenses. ResultsCaregivers reported that 53.2% of children had a vision screening at least once (if child ≤ 5 years) or within the past 2 years (if child > 5 years). Of those screened, 26.9% were referred to an eye doctor. Overall, 38.6% of all children had a previous eye doctor visit, and among them, 55.4% were prescribed corrective lenses during the visit. Factors associated with decreased odds of vision screening included younger age, lack of health care visits, no insurance coverage, parent education ≤ high school, and lower household income. Non-White ethnicities, households with a non-English primary language, and lower incomes were more likely to be referred to an eye doctor after vision screening. Lower rates of eye doctor visits were associated with younger age, lack of insurance coverage, and primary household languages other than English. ConclusionsChildren from disadvantaged backgrounds are less likely to receive vision screening and eye care. Targeted strategies are needed to increase vision screening and access to eye care services in these vulnerable groups.

Addressing Health Disparities in Pediatric Eye Care for School-Age Children: A Call to Action.

Disparities in access to pediatric eye care among school-age children pose significant challenges to their health and well-being; addressing these disparities will necessitate coordination across multiple systems. Although vision screenings are mandated in most US states, differences persist in terms of who receives screenings and subsequent follow-up care. Racial, ethnic, and socioeconomic factors exacerbate the issue, with potential ramifications of unaddressed eye problems on learning performance and the risk of widening preexisting educational disparities. To address these challenges, various initiatives and strategic plans have emphasized the need to improve access, enhance diversity in the workforce, and promote health literacy. School-based vision programs (SBVPs) have shown promise in improving access to care and academic outcomes, but issues with integration into the health care system exist. This article explores opportunities to address structural barriers, establish resilient and equitable systems for delivering pediatric eye care to school-age children, and leverage the success of SBVPs to build stronger connections with community providers. Proposed strategies include developing standardized guidelines; establishing referral mechanisms; fostering communication with parents, teachers, and community providers; and promoting eye health literacy across the school community. Collectively, these measures aim to improve health outcomes, address social determinants of health, and reduce disparities in access to care.

What We Learned About the Economic and Workforce Issues in Pediatric Ophthalmology: Access to Eye Care and Possible Solutions.

To provide a blueprint reviewing the major economic and workforce issues in pediatric ophthalmology and its effect on access to pediatric eye care, as well as potential solutions. This was a systematic review of the landmark studies examining the economic and workforce issues in pediatric ophthalmology was performed. The number of residents pursuing pediatric ophthalmology fellowship has steadily declined since the early 2000s. Increasing overhead costs, low Medicaid reimbursements, practice pattern changes, and workforce shortages have all contributed to a significant crisis in access to pediatric eye care. Solutions to improve access to pediatric eye care involve pursuing more economical strategies within the confines of the pediatric ophthalmology practice, early exposure to the field during medical education, and enhancing residents' interest through faculty mentorship. Low reimbursements are a major driver contributing to extended appointment wait times for pediatric ophthalmology visits at major academic eye centers. Legislative changes at both the federal and state levels are needed to make appropriate increases in reimbursements, starting with states in the lowest quartile of Medicaid reimbursements. [J Pediatr Ophthalmol Strabismus. 2023;60(5):323-329.].

The Burden of Pediatric Visual Impairment and Ocular Diagnoses in Barbados.

Visual impairment (VI) negatively affects a child's quality of life. The prevalence of VI in the Caribbean is nearly three times higher than in the United States, but the causes remain uncertain. This study leverages Barbados' unique eye care system to survey the eye diseases and VI prevalence in Barbadian children. Medical records of all patients aged <19 years who received ophthalmic care in Barbados' two public eye care centers between January and December 2019 were reviewed, capturing the entirety of public pediatric eye care within the study period. Age at the first visit to the clinic and at the final visit in 2019, sex, best-corrected visual acuity (BCVA), past medical history, and clinical diagnoses were extracted and analyzed. VI was defined as a BCVA of 6/12 or worse in the better-seeing eye. There were 3278 patient records with a mean age at the first visit of 7.8 ± 3.9 years. There were 80 (2.4%) children with VI, 62.5% of which were attributed to amblyopia. A total of 94% of VI was preventable or treatable. The most common diagnoses were refractive error (87.5%), strabismus (27.5%), and allergic eye disease (20.0%). Amblyopia is the major cause of pediatric VI in Barbados and is largely avoidable.

Potential blindness from nutritional xerophthalmia in autistic patients

Vitamin A is vital to retinal rod function and epithelial cell differentiation. Although uncommon in the developed world, vitamin A deficiency (VAD) secondary to poor diets or gastrointestinal disease has been reported and can lead to xerophthalmia, which is characterized by night blindness and a spectrum of ocular surface changes. Patients with autism spectrum disorder have been shown to have restrictive diets secondary to sensory issues leading to rejection of foods except for those of certain color or texture. We present a case series of 6 pediatric patients with autism who developed varying degrees of xerophthalmia due to VAD, which resulted from restrictive eating. All patients presented with a history of eye irritation that was not relieved by antibiotic or allergy eye drops. Further questioning revealed they had restrictive diets consisting of only or mostly white and tan foods, and serum vitamin A testing confirmed severe VAD. Most stages of xerophthalmia were completely reversed with vitamin A supplementation, but in 2 patients more advanced xerophthalmia resulted in irreversible blindness and ocular damage. Both pediatricians and pediatric eye care providers must be vigilant for VAD as an etiology of eye irritation, photophobia, or new-onset visual impairment in autistic children. A review of the child's diet must be implemented as a standard part of routine history taken in this vulnerable population. Early identification and vitamin A supplementation can prevent irreversible ocular compromise and vision loss.

Prescribing patterns for paediatric hyperopia among paediatric eye care providers.

To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia. Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age-based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov-Smirnov cumulative distribution function test. Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age-normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5-2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years. Prescribing patterns for paediatric hyperopia vary significantly among eye care providers.

Pediatric Eye Care Treatment Rates and Community Compliance to a Spectacle Provision Program in an Underserved School District in San Diego, CA.

The need for early identification and treatment of young children's refractive error needs has become a public health concern. The UCSD Eyemobile for Children (EyeMobile) provides vision screenings and comprehensive eye exams on the Eyemobile among a population of underserved, predominantly Hispanic preschool and elementary school children. The program also provides spectacles for children who fail eye exams due to refractive error. We performed a retrospective cross-sectional analysis of all children screened from 2011 to 2017 by the Eyemobile across 10 San Diego elementary schools. We examined demographics, distance and near visual acuity, autorefraction, stereopsis, and color vision. To measure compliance to our spectacle program, we checked if children who were prescribed spectacles were wearing them, as instructed, at the following year's screening. Differences between compliance measures with respect to school, age, ethnicity, and gender were determined using chi-square analysis, while all other measures were fit to a binary logistic regression to determine statistically significant factors. A total of 12,176 elementary school children were screened between 2011 and 2017. Of these children, 5269 (43.3%) were referred for a comprehensive eye examination. Across six years, 3163 (60.0%) of the children referred completed their eye examinations. There was a significant increase (p < 0.001) in exam completion in the successive years. Exam completion was significantly higher in ten-year-olds (p = 0.0278) and in 3 of the 10 schools (p < 0.0001, p = 0.0027, and p = 0.0309). A total of 1089 (8.9% of screened) children were prescribed spectacles. Of the 409 children that were recorded with the compliance method, 342 (83.6%) were found to be fully compliant and wearing their spectacles as prescribed. The Eyemobile program demonstrated high levels of compliance for both eye examination completion and prescribed spectacle wear in underserved populations in the San Diego region, compared to similar national programs.

Integration of hospital and community care for paediatric ophthalmology: A mixed-methods study.

To explore collaborative care models for paediatric eye care that integrate hospital and community-based care to address access blocks. Sequential referrals to a tertiary paediatric ophthalmology clinic between April and October 2019 and subsequent encounters up until July 2020 at a major metropolitan public children's hospital in Sydney, Australia, were reviewed to identify those cases suitable for community care. Semi-structured phone interviews were conducted with eye health service providers, including ophthalmologists, orthoptists and optometrists, as well as service users to explore their perspectives on potential changes to service delivery. Qualitative data were analysed deductively using the Levesque model for access to healthcare and Consolidated Framework for Implementation Research (CFIR) to inform implementation strategies for future models of care. One-third of the 439 audited referrals (30.5%; 134/439) were identified as suitable for community management. Interviews revealed five themes relating to potential models of care, which would support and promote access: integrated health systems, standardised quality of care, interprofessional trust, multidisciplinary governance and patient-centred care. Key recommendations for future implementation included: (i) identifying and preparing clinical champions, (ii) conducting educational meetings, (iii) conducting local needs assessments and (iv) informing local opinion leaders. This audit highlights access blocks and poor targeting of referrals to tertiary paediatric ophthalmology services in a metropolitan hospital. Integration with community practitioners was identified as an acceptable way to streamline services, and strategies that may support successful implementation in this setting were identified.

Parents' Awareness and Attitude Toward Pediatrics Eye Diseases in Makkah, Saudi Arabia: A Cross-Sectional Study.

The necessity of early detection and parents' knowledge of pediatric eye conditions and eye care is crucial, not only because of the severe complications it can carry, like blindness, but also due to the availability of preventive measures and the importance of vision in a child's growth and social life. Therefore, this study aimed to evaluate the level of awareness of and attitudes toward children's eye diseases of parents in Makkah City, Saudi Arabia. This descriptive, cross-sectional questionnaire-based study was conducted in Makkah, Saudi Arabia, from September to December 2022. A self-administered questionnaire was randomly distributed to fathers and mothers of children younger than 18 through social media platforms. A total of 470 parents who met the study's inclusion criteria completed the study questionnaire. The results showed that 72.8% of the parents had poor awareness of pediatric eye diseases, 24.5% had good awareness, and 2.8% had excellent awareness. With regard to the symptoms that might prompt parents to take their children to an eye specialist, eye redness had the highest percentage (24.5%). It was also shown that 68.5% would allow their children to undergo eye surgery, if necessary, while most of those who refused to do so (11.3%) cited fear of the surgical outcome as the cause of their refusal. Our study findings show inadequate parental knowledge about common pediatric eye diseases and eye care practices for children. Therefore, awareness andeducation programs targeting both parents are recommended to raise the parents' level of awareness of pediatric eye diseases and to improve their attitudes toward the same.

Assessment of parental awareness about pediatric visual problems by Knowledge-Attitude-Practice survey in South India

To find out parents' knowledge, attitude, and treatment practice (KAP) toward pediatric eye problems and to assess the effect of demographic factors such as gender, age, educational status, and number of children on KAP.A cross-sectional descriptive study was conducted in a hospital setting. Two hundred parents were randomly selected for the questionnaire. All parents had children who were included in Systematic Pediatric Eye Care Through Sibling Screening Strategies (SPECSSS) study. A survey with 15 questions on KAP of pediatric eye diseases was prepared and administered to parents coming to a tertiary eye hospital with varied experience and education qualifications.The mean age of 200 patients was 9.6 (3.4) years, with the majority of them male (n = 110; 55.0%). The majority of the children (n = 91, 45.5%) were between the age group of 6-10 years. Knowledge of visual problems among parents was of a good grade in 9% only. The attitude of the parents toward the visual problem was positive at 17%, and the responses regarding the practice were of excellent grade at 46.5% and good at 26.5%. Analysis suggests that the level of knowledge and practice were not significantly associated with the demographic factors (p > 0.05). The positive attitude toward the visual problems of the children was associated with education of the parents (p < 0.05) and the father occupation (p < 0.05).Knowledge about pediatric eye diseases was poor among parents and it was significantly affected by education and occupation of parents. The parents have positive attitude toward enhancing their attitude in treatment.