Eye Care Practices Research Articles

Knowledge and attitude of essential newborn care among postnatal mothers in Bangladesh

Purpose Neonatal mortality rate is 24 deaths per 1,000 live births in Bangladesh and most of them die during early neonatal period. The purpose of this paper is to assess the knowledge and attitude of neonatal care practices among postnatal mothers in a tertiary care hospital in order to provide a basis for the development of strategies to improve further. Design/methodology/approach A cross-sectional study was carried out in the Dhaka Medical College Hospital, Bangladesh using a convenient sampling technique. In total 211 postnatal mothers were interviewed using a structured questionnaire and χ2 test was used to analyze the data. Findings Among mothers, 37.9 percent were aged between 16–20 years; 16.1 percent had no institutional education; 55 percent were primipara and only 26.5 percent had attended antenatal visit for more than four times. Mothers had apparently good knowledge and attitude about thermoregulation, early initiation of breast-feeding, importance of providing colostrum to the newborn, exclusive breast-feeding (EBF) up to six months of age and immunization at birth. However, this study identified knowledge gap about cord care, eye care, first bathing and hygiene practices. Overall, only a small proportion of respondents had good level of knowledge (37 percent) and attitude (47.4 percent) on newborn care. Highly significant statistical association was found between the knowledge, attitude level and socio-demographic characteristics of respondents. Knowledge and attitude were strongly associated as well. Research limitations/implications There is scope for improvement by providing health education to antenatal and postnatal mothers. Therefore, implementation of the guidelines outlined in the Maternal and Child Handbook (MCH) is highly recommended. Originality/value There is scope for improvement by providing health education to antenatal and postnatal mothers. Therefore, implementation of the guidelines outlined in the MCH is highly recommended to enhance the knowledge and attitude on newborn care among postnatal mothers.

PREVALENCE OF VITREOMACULAR ADHESION IN PATIENTS WITHOUT MACULOPATHY OLDER THAN 40 YEARS.

To determine the prevalence and factors influencing vitreomacular adhesion (VMA) or vitreomacular traction (VMT) in subjects without maculopathy older than age 40 years. In a prospective cross-sectional study, 1,950 eyes in 1,090 participants aged 40 to 89 years representing various ethnic groups from 14 centers in the United States underwent a comprehensive eye examination, including spectral domain optical coherence tomography. A team of independent, masked readers classified the presence or absence of VMA/VMT on spectral domain optical coherence tomography based on the International Vitreomacular Traction Study Group rubric. Across all eyes, the prevalence of VMA or VMT was 39% or 1%, respectively. For every 1-year increase in age, there was a statistically significant 7% decreased odds of having VMA or VMT (95% confidence interval [CI]: 0.89-0.96; P < 0.001), whereas African Americans had 55% significantly reduced odds of having VMA or VMT when than whites (95% CI: 0.23-0.90; P = 0.025). Vitreomacular adhesion >1,500 μm was significantly more likely than VMA <1,500 μm in younger adults (95% CI: 0.70-0.86; P < 0.001), hyperopes versus emmetropes (95% CI: 1.49-35.9; P = 0.01), primary eye care versus tertiary practices (95% CI: 0.03-0.92; P = 0.04), and patients without hyperlipidemia (95% CI: 0.04-0.83; P = 0.03). Vitreomacular adhesion is highly prevalent among middle-aged adults. Diagnostic screening with spectral domain optical coherence tomography may help to accurately detect VMA or VMT, prompting routine monitoring and timely therapeutic intervention.

Indian Diabetic Retinopathy Image Dataset (IDRiD): A Database for Diabetic Retinopathy Screening Research

Diabetic Retinopathy is the most prevalent cause of avoidable vision impairment, mainly affecting the working-age population in the world. Recent research has given a better understanding of the requirement in clinical eye care practice to identify better and cheaper ways of identification, management, diagnosis and treatment of retinal disease. The importance of diabetic retinopathy screening programs and difficulty in achieving reliable early diagnosis of diabetic retinopathy at a reasonable cost needs attention to develop computer-aided diagnosis tool. Computer-aided disease diagnosis in retinal image analysis could ease mass screening of populations with diabetes mellitus and help clinicians in utilizing their time more efficiently. The recent technological advances in computing power, communication systems, and machine learning techniques provide opportunities to the biomedical engineers and computer scientists to meet the requirements of clinical practice. Diverse and representative retinal image sets are essential for developing and testing digital screening programs and the automated algorithms at their core. To the best of our knowledge, IDRiD (Indian Diabetic Retinopathy Image Dataset), is the first database representative of an Indian population. It constitutes typical diabetic retinopathy lesions and normal retinal structures annotated at a pixel level. The dataset provides information on the disease severity of diabetic retinopathy, and diabetic macular edema for each image. This makes it perfect for development and evaluation of image analysis algorithms for early detection of diabetic retinopathy.

Feedback: Audiology interactive

Bill Harvey discusses your responses to our recent interactive CET exercise concerning hearing impairment and its impact upon eye care practice

Cornea and anterior eye assessment with slit lamp biomicroscopy, specular microscopy, confocal microscopy, and ultrasound biomicroscopy.

Current corneal assessment technologies make the process of corneal evaluation extremely fast and simple, and several devices and technologies show signs that help in identification of different diseases thereby, helping in diagnosis, management, and follow-up of patients. The purpose of this review is to present and update readers on the evaluation of cornea and ocular surface. This first part reviews a description of slit lamp biomicroscopy (SLB), endothelial specular microscopy, confocal microscopy, and ultrasound biomicroscopy examination techniques and the second part describes the corneal topography and tomography, providing up-to-date information on the clinical recommendations of these techniques in eye care practice. Although the SLB is a traditional technique, it is of paramount importance in clinical diagnosis and compulsory when an eye test is conducted in primary or specialist eye care practice. Different techniques allow the early diagnosis of many diseases, especially when clinical signs have not yet become apparent and visible with SLB. These techniques also allow for patient follow-up in several clinical conditions or diseases, facilitating clinical decisions and improving knowledge regarding the corneal anatomy.

Cornea and anterior eye assessment with placido-disc keratoscopy, slit scanning evaluation topography and scheimpflug imaging tomography.

Current corneal assessment technologies make the process of corneal evaluation extremely fast and simple and several devices and technologies allow to explore and to manage patients. The purpose of this special issue is to present and also to update in the evaluation of cornea and ocular surface and this second part, reviews a description of the corneal topography and tomography techniques, providing updated information of the clinical recommendations of these techniques in eye care practice. Placido-based topographers started an exciting anterior corneal surface analysis that allows the development of current corneal tomographers that provide a full three-dimensional reconstruction of the cornea including elevation, curvature, and pachymetry data of anterior and posterior corneal surfaces. Although, there is not an accepted reference standard technology for corneal topography description and it is not possible to determine which device produces the most accurate topographic measurements, placido-based topographers are a valuable technology to be used in primary eye care and corneal tomograhers expanding the possibilities to explore cornea and anterior eye facilitating diagnosis and follow-up in several situations, raising patient follow-up, and improving the knowledge regarding to the corneal anatomy. Main disadvantages of placido-based topographers include the absence of information about the posterior corneal surface and limited corneal surface coverage without data from the para-central and/or peripheral corneal surface. However, corneal tomographers show repeatable anterior and posterior corneal surfaces measurements, providing full corneal thickness data improving cornea, and anterior surface assessment. However, differences between devices suggest that they are not interchangeable in clinical practice.

Anterior segment optical coherence tomography for evaluation of cornea and ocular surface.

Current corneal assessment technologies make the process of corneal evaluation extremely fast and simple. Several devices and technologies allow to explore and manage patients better. Optical coherence tomography (OCT) technology has evolved over the years, and hence a detailed evaluation of anterior segment (AS) structures such as cornea, conjunctiva, tear meniscus, anterior chamber, iris, and crystalline lens has been possible in a noncontact and safe procedure. The purpose of this special issue is to present and update in the evaluation of cornea and ocular surface, and this paper reviews a description of the AS-OCT, presenting the technology and common clinical uses of OCT in the management of diseases involving cornea and ocular surface to provide an updated information of the clinical recommendations of this technique in eye care practice.

Concept of primary eye care &amp; school health in India

Primary eye care consists of promotive, preventive and curative actions by trained personnel or other interested people. Teachers are the best manpower to be trained for this purpose since they are more close to the students always. Poor visual function during early childhood may have several adverse outcomes. Through the school children, health messages can be propagated to their families, friends and peer groups. Training school teachers and empowering students and other staff of the school on simple and safe eye care practices through organized activities may come out as a cost effective way of improving general health and academic performance.

Evaluation of content and cost of traditional eye medication in a resource-poor country - Implications for eye care practice and policy.

Cataract, glaucoma, and conjunctivitis are common causes of ocular morbidity in Nigeria. A major obstacle in reducing the burden of ocular morbidity in rural areas is access to eye care services. Up to 80% of the population in developing countries use traditional medications for their primary healthcare needs because they are accessible, available, and affordable. The aim of this study is to evaluate the content and cost of commercialized traditional medications used in the treatment of common eye conditions in Nigeria. All the registered traditional healers (THs) at an International Trade Fair in Enugu who treated eye problems were identified. Data on their location and scope of their practice were collected by the researchers. Proxy patients consulted THs in the trade fair with simulated cataract, glaucoma, and bacterial conjunctivitis, and treatment was sought. Medication for the treatment of the simulated disorders was paid for and procured. The mode of administration and the cost of the drugs were recorded by proxy patients. Each medication was labeled with a code and sent to the laboratories of the National Agency for Drug Administration and Control for analysis. Data were entered into a database on Microsoft Access and transferred to STATA V12.1 (StataCorp) for analysis. Cataract was treated by 87.5% of all the traditional eye healers interviewed. A total of 32 samples were collected and analyzed. These comprised mainly oral (53.1%) and topical traditional medications (43.8%). The pH of the topical samples ranged from 3.5 to 10, while the mean microbiological load per topical solution was 3.3 × 104 cfu/mL ± 0.96. The cost of treatment of cataract ranged from 4 to 70 USD. The content of the majority of the samples of traditional eye medications in this study had high extremes of pH and/or had a high microbial content. The practice of THs should be regulated.

Use of traditional eye medicine and self-medication in rural India: A population-based study.

ObjectiveTo determine the type and nature of traditional eye medicine (TEM), their sources and use and practices related to self-medication for ophthalmic diseases in a rural Indian population.MethodsA population-based, cross-sectional study was conducted in 25 randomly selected clusters of Rural Gurgaon, Haryana, India as part of CORE (Cornea Opacity Rural Epidemiological) study. In addition to comprehensive ophthalmic examination, health-seeking behavior and use of self-medication and TEM was assessed in the adult population using a semi-structured questionnaire. Physical verification of available ophthalmic medications in the enumerated households was conducted by the study team. Descriptive statistics were computed along with multivariable logistic regression analysis to determine associated factors for use of self-medication and TEM.ResultsOf the 2160 participants interviewed, 396 (18.2%) reported using ophthalmic medications without consulting an ophthalmologist, mainly for symptoms like watering (37.1%), redness (27.7%), itching (19.2%) and infection (13.6%). On physical verification of available eye drops that were being used without prescription, 26.4% participants were practicing self-medication. Steroid, expired/unlabeled and indigenous eye drops were being used by 151(26.5%), 120(21.1%) and 75 (13.2%) participants respectively. Additionally, 25.7% (529) participants resorted to home remedies like ‘kajal’(61.4%), honey (31.4%), ghee (11.7%) and rose water (9.1%).ConclusionUse of TEM is prevalent in this population. The rampant use of steroid eye drops without prescription along with use of expired or unlabelled eye drops warrants greater emphasis on safe eye care practices in this population. Public awareness and regulatory legislations must be implemented to decrease harmful effects arising due to such practices.

Eye care practices among commercial drivers in a developing country

Objective: Vision is regarded as the most important source of information during driving. The need for good eye care practices among the commercial drivers therefore cannot be overemphasized. This study aimed to determine the eye care practices of commercial drivers in a developing country and their association with involvement in road traffic crash (RTC). Methods: A cross-sectional descriptive study was carried out among 328 registered commercial drivers in Ilorin metropolis, Kwara State, Nigeria. Multistage random sampling method was used to select the participants while semi-structured, interviewer administered questionnaire was used to obtain information on the socio-demography, eye care practices and involvement in RTC. Results: Data was analysed using SPSS version 18. The level of significance was set at p -value of less or equal to 0.05. Most (75.8%) of the commercial drivers had clear knowledge on good eye care practices. Majority, 79.6% of them had poor eye care practice. Only one-fifth of the drivers who practice good eye care had been involved in RTC in the last five years ( p = 0.548). There was no statistically significant association between good eye care practices and involvement in RTC. Conclusion: Good eye care practice especially regular eye check at the hospital can help in early detection of poor visual function to enable prompt intervention. The consequences of RTC could be very fatal, it is therefore imperative for commercial drivers to always exhibit good eye care practices bearing in mind the major role of vision in driving. Keywords: Eye care practice, Commercial drivers, Road traffic crash, Developing country

Prevalence of Undiagnosed Age-Related Macular Degeneration in Primary Eye Care

Age-related macular degeneration (AMD) is the leading cause of irreversible vision impairment in older adults in the United States, yet little is known about whether AMD is appropriately diagnosed in primary eye care. To examine the prevalence of eyes with AMD in patients seen in primary eye care clinics who purportedly have normal macular health per their medical record and the association of AMD with patient and physician characteristics. In this cross-sectional study of primary eye care practices in Birmingham, Alabama, 644 persons 60 years or older with normal macular health per medical record based on their most recent dilated comprehensive eye examination by a primary eye care ophthalmologist or optometrist were enrolled from May 1, 2009, through December 31, 2011. Data analysis was performed from May 1, 2016, through December 20, 2016. Presence of AMD as defined by the Clinical Age-Related Maculopathy Staging system based on color fundus photography and a masked grader. Types of AMD-associated lesions were noted. Patient health and physician characteristics were collected. The sample consisted of 1288 eyes from 644 participants (231 [35.9%] male and 413 [64.1%] female; mean [SD] age, 69.4 [6.1] years; 611 white [94.9%]) seen by 31 primary eye care ophthalmologists or optometrists. A total of 968 eyes (75.2%) had no AMD, in agreement with their medical record; 320 (24.8%) had AMD despite no diagnosis of AMD in the medical record. Among eyes with undiagnosed AMD, 32 (10.0%) had hyperpigmentation, 43 (13.4%) had hypopigmentation, 249 (77.8%) had small drusen, 250 (78.1%) had intermediate drusen, and 96 (30.0%) had large drusen. Undiagnosed AMD was associated with older patient age (odds ratio [OR], 1.06; 95% CI, 1.04-1.09; P < .001), male sex (age-adjusted OR, 1.39; 95% CI, 1.02-1.91; P = .04), and less than a high school education (age-adjusted OR, 2.40; 95% CI, 1.03-5.62; P = .04). Prevalence of undiagnosed AMD was not different for ophthalmologists and optometrists (age adjusted OR, 0.99; 95% CI, 0.71-1.36; P = .94). Approximately 25.0% of eyes deemed to be normal based on dilated eye examination by primary eye care physicians had macular characteristics that indicated AMD revealed by fundus photography and trained raters. A total of 30.0% of eyes with undiagnosed AMD had AMD with large drusen that would have been treatable with nutritional supplements had it been diagnosed. Improved AMD detection strategies may be needed in primary eye care as more effective treatment strategies for early AMD become available in the coming years.

The non-verbal patient

Andy Millington looks at the underlying causes preventing some patients from speaking and addresses how best to manage them in eye care practice.

Factors in the success of new contact lens wearers.

To determine the first-year retention rate for patients fitted with contact lenses (CLs) and identify factors associated with retention and dropout. This multi-site study was a retrospective chart review of the status of neophyte CL wearers fitted in representative UK eye care practices. Consecutive records for 524 patients at 29 sites were reviewed. Mean age at dispensing was 34 years (range 8-79), 68% were under 45 years and 61% female. Soft CLs were fitted to 98% of patients. After 12 months, 388 were still CL wearers, a retention rate of 74% (95% CI: 70.1-77.6). Of the 136 lapsed, 25% discontinued during the first month and 47% within 60 days. The main reasons cited for discontinuation included poor distance vision (26%; of whom, 37% were toric and 51% multifocal), poor near vision (16%), discomfort (14%) and handling problems (15%). In 32% of cases, the reasons for discontinuation were unknown. For 71% of dropouts, no alternative lens or management strategy had been tried. Significant factors associated with retention in univariate analysis were: age (younger), sphere power (higher), lens type (sphere vs multifocal) and purchase frequency (regular). Multivariate analysis showed lens sphere power, purchase frequency and lens material to be significant factors. There was a wide variation in retention rates between sites (40-100%). During the first year of CL wear, the overall retention rate for neophyte CL wearers was 74% (spherical CLs 79%, torics 73%, multifocals 57%), with many lapsing during the first 2 months. Factors associated with retention and dropout in these patients include: lens power, material and type, and purchase frequency. While handling and comfort are the most commonly cited performance-related reasons for discontinuing in new spherical lens wearers, visual problems are the most common among new wearers of toric and, in particular, multifocal CLs.

Information storage and transfer part 1: cyber security

Increasingly, clinical information is stored, modified, analysed or transferred in digital form. In the first in a series Dr Douglas Clarkson looks at the legal ramifications of digital technology on eye care practice.

Headaches in optometric practice part 7: migraine linked to hole in the heart

In the final part of our series looking at some of the more unusual underlying causes of headache that may present in community eye care practice, Kirit Patel describes a case where a congenital weakness of the heart was identified as the problem.

Development of Visual Field Screening Procedures: A Case Study of the Octopus Perimeter.

PurposeWe develop a methodology for designing perimetric screening procedures, using Octopus perimeters as a case study.MethodsThe process has three stages: analytically determining specificity and number of presentations required for different multisampling suprathreshold schemes at a single location of the visual field, ranking visual field locations by their positive predictive value (PPV) for glaucoma, and determining a pass/fail criteria for the test. For the case study the Octopus G-program visual field test pattern is used, and a dataset of 385 glaucoma and 86 normal patients.ResultsUsing a 1-of-3 sampling strategy at a level equal to the 95 percentile of normal observers gave the most robust specificity under the influences of false-negative responses using an average of 1.5 presentations per location. The PPV analysis gave 19 locations that completely classified our glaucomatous data. A further 9 points were added to screen for nonglaucomatous loss. The final stage found that insisting that 3 locations are missed for the screening to fail gave a simulated specificity and sensitivity of approximately 95% for unreliable responders.ConclusionsOur method gives a principled approach to choosing between the many parameters of a visual field screening procedure. We have developed a procedure for the Octopus that should terminate in less than 1 minute for normal observers with high specificity and sensitivity to glaucoma.Translational RelevanceVisual field screening is used in community settings and eye care practice. This study provides a principled approach to the development of such screening procedures and details a new procedure.

Litigation and the practitioner - part 1

In the first of a series on the legal framework governing eye care practice Dr Nizar K Hirji discusses some recent landmark cases and reviews the sources of law

Eye Care by Dutch Nursing Home Physicians: A Descriptive Study

&lt;p&gt;Currently, 4% of older adults reside in long-term care facilities in the Netherlands. Nursing home residents tend to have multimorbidity that is associated with considerable disabilities and a high level of care dependency. In the Dutch adult population the highest estimated prevalence (&amp;gt;40%) of visual impairment (low vision and blindness) was found in the subgroup of residents in nursing homes (NHs). The aim of this study is to describe the current practice of eye care by Dutch nursing home physicians (NHPs).&lt;/p&gt;&lt;p&gt;A digital online survey was developed to describe the eye care activities of nursing home physicians and their cooperation in this perspective with other professionals.&lt;/p&gt;&lt;p&gt;Of 1573 NHPs present in the Netherlands, 125 (8%) responded.&lt;/p&gt;&lt;p&gt;Results show that more than 50% of the NHPs regularly examine ‘distant vision’, ‘near vision’ and ‘the visual field’. However, 23%, 33% and 45% almost never or never examine the ‘visual field’, ‘near vision’ and ‘distant vision’, respectively. Data regarding eye care, regularly recorded in the client files by more than 50% of the NHPs, are medical data involving ‘use of eye medication’, ‘eye disease’, and ‘eye surgery in the past’. Less commonly recorded is ‘the use of reading glasses’ as well as ‘eye pain’.&lt;/p&gt;&lt;p&gt;Inside of the NH, (head) nurses and ward nurses (chi&lt;sup&gt;2&lt;/sup&gt; = 309, df = 5, p = 0.000), and outside of the NH, ophthalmologists and low vision specialists are most frequently contacted about eye related issues (chi&lt;sup&gt;2&lt;/sup&gt; = 224, df = 4, p = 0.000). Opticians are rarely contacted, and optometrists and orthoptists are ‘never’ contacted by more than 50% of the NHPs. Moreover, 50% of the NHPs noted that collaboration with external eye care professionals is ‘not structural’.&lt;/p&gt;&lt;p&gt;This study shows that, according to NHPs, relevant visual aspects are not structurally examined and recorded in the client files. Outside of the NH, NHPs tend to have a less frequent collaborative relationship with optometrists, orthoptists and opticians compared to ophthalmologists and low vision specialists. The NHP’s role in providing eye care can be improved by development of guidelines for structural eye screening, improvement of recording in client files, and exploring plus undertaking collaboration with other eye care professionals.&lt;/p&gt;

Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) for adults at risk for glaucoma: study rationale and design.

BackgroundPrimary open angle glaucoma is a chronic, progressive eye disease that is the leading cause of blindness among African Americans. Glaucoma progresses more rapidly and appears about 10 years earlier in African Americans as compared to whites. African Americans are also less likely to receive comprehensive eye care when glaucoma could be detected before irreversible blindness. Screening and follow-up protocols for managing glaucoma recommended by eye-care professional organizations are often not followed by primary eye-care providers, both ophthalmologists and optometrists. There is a pressing need to improve both the accessibility and quality of glaucoma care for African Americans. Telemedicine may be an effective solution for improving management and diagnosis of glaucoma because it depends on ocular imaging and tests that can be electronically transmitted to remote reading centers where tertiary care specialists can examine the results. We describe the Eye Care Quality and Accessibility Improvement in the Community project (EQUALITY), set to evaluate a teleglaucoma program deployed in retail-based primary eye care practices serving communities with a large percentage of African Americans.Methods/DesignWe conducted an observational, 1-year prospective study based in two Walmart Vision Centers in Alabama staffed by primary care optometrists. EQUALITY focuses on new or existing adult patients who are at-risk for glaucoma or already diagnosed with glaucoma. Patients receive dilated comprehensive examinations and diagnostic testing for glaucoma, followed by the optometrist’s diagnosis and a preliminary management plan. Results are transmitted to a glaucoma reading center where ophthalmologists who completed fellowship training in glaucoma review results and provide feedback to the optometrist, who manages the care of the patient. Patients also receive eye health education about glaucoma and comprehensive eye care. Research questions include diagnostic and management agreement between providers, the impact of eye health education on patients’ knowledge and adherence to follow-up and medication, patient satisfaction, program cost-effectiveness, and EQUALITY’s impact on Walmart pharmacy prescription rates.DiscussionAs eye-care delivery systems in the US strive to improve quality while reducing costs, telemedicine programs including teleglaucoma initiatives such as EQUALITY could contribute toward reaching this goal, particularly among underserved populations at-risk for chronic blinding diseases.