Routine Eye Care Research Articles

Most State Medicaid Programs Cover Routine Eye Exams For Adults, But Coverage Of Other Routine Vision Services Varies.

More than twelve million US adults ages forty and older are affected by vision impairment, and projections suggest that this number will double by 2050. Although most vision impairment can be eliminated with corrective lenses, many adults lack access to routine eye care. In this study, we analyzed detailed state-by-state Medicaid policies for 2022 and documented variability in coverage for adult vision services. Most fee-for-service Medicaid programs covered routine eye exams, although many did not cover glasses (twenty states) or low vision aids (thirty-five states), and about two-thirds of states with routine coverage required enrollee cost sharing. Managed care plans generally provided consistent or enhanced coverage relative to fee-for-service programs, although coverage sometimes varied between plans within a state. We estimated that about 6.5million and 14.6million adult enrollees resided in states without comprehensive coverage for routine eye exams and glasses, respectively. These findings reveal important gaps and opportunities for states to increase access to routine vision care.

Factors Influencing Vision Health and Eye Care among Older Adults in Northeast Tennessee.

The purpose of this study was to examine the factors associated with vision impairment (VI), age-related eye disease (ARED), and frequency of eye examinations among older adults. A cross-sectional study (N = 166) was designed to identify barriers in vision and eye care services among adults 50 years and older in four counties in Appalachian Tennessee. Surveys were administered in March 2023. Simple and multiple logistic regression analyses were used to determine the risk factors of VI and ARED and the frequency of eye examinations. In two out of the three regression models, predictors such as traveling >10 mi to an eye care provider, barriers to eye care, and a lack of exposure to eye health information emerged as significant factors. Individuals who traveled >10 mi to an eye care provider were more than twice as likely than individuals who traveled shorter distances to have VI and not maintain routine eye care (adjusted odds ratio [AOR] 2.69, 95% confidence interval [CI] 1.08-6.75; AOR 2.82, 95% CI 1.05-7.55, respectively). Reporting barriers to eye care doubled the odds of ARED (AOR 2.33, 95% CI 1.02-5.34) and substantially increased the odds of reporting a 3-year or longer interval since the last eye examination (AOR 7.45, 95% CI 1.85-29.96) compared with having no barriers to eye care. Moreover, limited exposure to eye health information tripled the odds of VI (AOR 3.26, 95% CI 1.15-9.24) and not maintaining routine eye care (AOR 3.07, 95% CI 0.97-9.70) compared with more exposure to eye health information. Other predictors also were uncovered in the analysis. This study contributes to the scarce literature on risk factors associated with vision health among older adults in Appalachia.

Imaging performance of portable and conventional ultrasound imaging technologies for ophthalmic applications.

The aim of this study was to evaluate the imaging capabilities of Butterfly iQ with conventional ophthalmic (piezoelectric) ultrasound (COU) for ophthalmic imaging. Custom phantom molds were designed and imaged with Butterfly iQ and COU to compare spatial resolution capabilities. To evaluate the clinical imaging performance of Butterfly iQ and COU, a survey containing pathological conditions from human subjects, imaged with both Butterfly iQ and COU probes, was given to three retina specialists and graded on image detail, resolution, quality, and diagnostic confidence on a ten-point Likert scale. Kruskal-Wallis analysis was performed for survey responses. Butterfly iQ and COU had comparable capabilities for imaging small axial and lateral phantom features (down to 0.1 mm) of high and low acoustic reflectivity. One of three retina specialists demonstrated a statistically significant preference for COU related to resolution, detail, and diagnostic confidence, but the remaining graders showed no significant preference for Butterfly iQ or COU across all sample images presented. The emergence of portable ultrasound probes offers an affordable alternative to COU technologies with comparable qualitative imaging resolution down to 0.1 mm. These findings suggest the value to further study the use of portable ultrasound systems and their utility in routine eye care.

A LITERATURE REVIEW ON MEDICATIONS MENTIONED FOR EYE DISEASES (KAN NOIGAL) IN SELECTED SIDDHA LITERATURES

BACKGROUND: Eye care and treatment has been given much prominence in the siddha system of medicine from time immemorial. The types of eye disorders, their etiology, treatment, and preventive measures to protect the eye from the diseases are all mentioned in various siddha literatures. OBJECTIVE: To provide an updated overview of medicines used for eye diseases in siddha literatures and to list out the medications used in eye diseases. MATERIALS AND METHODS: The data about eye diseases and its treatment are collected from Government Siddha Medical College Library, Central Council for Research in Siddha Library, Anna Centenary Library, Siddha literatures such as Agathiyar Nayana vidhi, Nagamuni Nayana vidhi, Sarabendra vaithiya muraigal (Nayana Roga Chigichai), Anuboga Vaithiya Navaneedham, Kannusamy Parambarai Vaithiyam etc and also the information about eye diseases is collected from the articles published in reputed journals such as Pubmed and google scholar. RESULT: The study will be useful for standardization and evaluation of eye medications and beneficial for future generations to carry out the research process on new eye medications. CONCLUSION: There is a need to understand the importance of routine eye care because any impairment in our vision leads to dependency on others. So I conclude that this study will be beneficial for routine eye care and the research process on new eye medications.

Automated expert-level scleral spur detection and quantitative biometric analysis on the ANTERION anterior segment OCT system

AimTo perform an independent validation of deep learning (DL) algorithms for automated scleral spur detection and measurement of scleral spur-based biometric parameters in anterior segment optical coherence tomography (AS-OCT) images.MethodsPatients...

Barriers in older adults’ decision-making process to use routine eye examinations in Hong Kong

ABSTRACT Clinical relevance The decision to have a routine eye examination involves individual- and service-level judgement. A deeper understanding of patient access barriers and expectations could facilitate the design of better-aligned service models in optometric practice, improving the utilisation rate of an important facet of primary healthcare services. Background Routine eye examinations achieve several health objectives, including mitigation of sight-threatening risk factors. However, there are barriers to service uptake. Through the qualitative approach, a deeper understanding of these barriers can be realised and enhanced strategies designed to improve the uptake of the routine eye examination. A qualitative study was conducted to identify the factors influencing the decision-making process of older adults to use the routine eye examination service. Methods This study was guided by the grounded theory approach. Participants were purposively recruited from six community elderly centres. Semi-structured interviews were conducted with 25 community-dwelling adults aged 65 years or above in Hong Kong. Data were transcribed and constant comparison techniques were used for data analysis. Results Difficulty in prioritising and including the routine eye examination in the existing health service utilisation was the central theme associated with its lower use. Four sub-themes were identified to explain this phenomenon: (1) previous health care service utilisation as a reference for judging primary eye care; (2) low perceived primary eye care service needs; (3) low perceived self-efficacy on routine eye care utilisation; (4) service expectations. Conclusion Multiple modifiable factors influence decision-making by older adults, suggesting that their routine eye care seeking behaviour might be altered through behaviour change intervention. The context in which services are delivered requires further study, with a focus on exploring the factors influencing service experience and its subsequent impact on regular eye care seeking behaviour.

Current Challenges and Solution of Ophthalmology during Covid-19: An evidence-based practice

Background: The coronavirus 2019, also known as SARS-CoV-2, is highly contagious and spreads easily through respiratory droplets when an infected person coughs or sneezes. In December 2019 Wuhan China, the virus was first detected and has become a global pandemic. Aim: To maintain an evidence-based ophthalmology practice during the Covid-19 pandemic, some strategies and guidelines that may be considered and to adapt their practices to the challenges presented by the Covid-19 pandemic while still maintaining evidence-based care. Methods: This narrative review study was conducted in ophthalmology department of Akbar Niazi Teaching Hospital (ANTH), Islamabad between January and March 2023. Some guidelines during Covid-19 outbreak were discussed. Results: Identifying and addressing challenges in different care settings is important for maintaining high-quality ophthalmology care during the Covid-19. Minimizing cross-infection of Covid-19 is essential in healthcare settings to protect both healthcare workers and patients. Stringent infection control measures with personal protective equipment (PPE) and routine cleaning of "high-touch" surfaces, are important strategies to reduce the risk of transmission. Implementing a stringent dual screening and triaging process is a crucial step for outpatient care during the Covid-19 pandemic. This helps to identify high-risk patients and provide appropriate care while minimizing the risk of transmission to other patients and healthcare workers. Separating inpatient and outpatient care is another important strategy to minimize interactions and reduce the risk of transmission of Covid-19. Planning logistics and manpower is critical during the Covid-19 pandemic to ensure that healthcare facilities have the necessary resources and staff to meet the needs of patients. The practical implication of this review was to develop strategies for safe routine eye care and surgery to maintain practice. Conclusion: The measures implemented in response to the Covid-19 in ophthalmology clinics can serve as a guide for healthcare facilities facing similar disease outbreaks in the future. Keywords: Challenges; Evidence-based practice; Ophthalmology; SARS-CoV-2.

Ocular Trauma Management: A VR Surgeon’s Perspective

In our routine eye care practice, most of us frequently see patients with ocular trauma. It may vary from a small foreign body on the cornea causing discomfort, redness and pain with no significant visual complaints to a totally ruptured globe causing complete loss of vision or only the presence of light perception in the injured eye. These patients get treated differently in proportion to different parts of the country and the availability of medical support

Effectiveness of early essential newborn care implementation in four counties of western China

BackgroundNeonatal survival is a public health concern globally. However, the regional disparity in neonatal mortality between rural counties of western China and urban areas of eastern provinces remains high. Early essential newborn care (EENC), recommended by World Health Organization, refers to a set of cost-effective interventions to improve neonatal health and development outcomes. In this study, we aimed to explore the effectiveness of EENC implementation in four counties of western China.MethodsPre- and post-intervention investigations were conducted in four selected EENC intervention counties and four control counties of four western provinces of China, from June to August 2017 and from December 2020 to April 2021 respectively. A mixed quantitative and qualitative approach was used for data collection and analysis. Data on the coverage of EENC practices were collected via a post-intervention face-to-face questionnaire survey with postpartum mothers before hospital discharge. Hospital-reported data on neonatal health indicators were obtained through mail surveys in both investigations. We also performed semi-structured interviews with policymakers, health staff and postpartum mothers to understand their perceptions about the usefulness of EENC implementation.ResultsOverall, 599 mother-newborn pairs in the intervention group and 699 pairs in the control group participated in the post-intervention survey. Controlling for the confounding factor of province, the proportion of newborns receiving EENC interventions was higher in the intervention group than in the control group (P < 0.05). Intervention groups in four provinces had higher coverage of: any skin-to-skin contact (99.50% vs. 49.07%); early breastfeeding initiation (within 60 min of birth) (90.84% vs. 80.35%); no medicine applied to the umbilical cord (98.50% vs. 9.73%); routine eye care (93.16% vs. 8.73%); and vitamin K1 administration (98.33% vs. 88.98%). EENC implementation was associated with decreased risk of neonatal diarrhea (OR: 0.326, 95% CI: 0.123, 0.865) and eye infection (OR: 0.147, 95% CI: 0.045, 0.483). Policymakers, health staff and postpartum mothers expressed satisfaction with the EENC interventions, noting a willingness among staff and policymakers to implement and sustain these interventions; the promotion of these interventions within hospital policy; the positive emotions experienced by postpartum mothers; perceived improvements in health; and improvements in support for health workers.ConclusionEENC-recommended core practices (except kangaroo mother care) have been successfully introduced in pilot hospitals. The efficacy of EENC implementation should be highly recognized to accelerate the progress towards its national roll out.

Barriers to Care in the Treatment of Glaucoma: Socioeconomic Elements That Impact the Diagnosis, Treatment, and Outcomes in Glaucoma Patients.

Purpose of ReviewThis article reviews socioeconomic elements that impact the access to glaucoma care, early intervention in susceptible patients, and longevity of treatment and patient compliance in various demographic groups.Recent FindingsSocioeconomic factors such as insurance eligibility, education, income, marital status, and access to technology can deeply impact the diagnosis and long-term treatment of glaucoma patients. Depending on the severity, and/or urgency of care, many individuals who face these barriers forgo annual eye exams, leading to a higher incidence of untreated glaucoma.SummaryEarly intervention and regular follow-up are essential for patient compliance in the management of glaucoma. Routine eye care leads to earlier detection and can improve management options and reduce the severity of disease burden.

Prevalence of diabetic retinopathy and self-reported barriers to eye care among patients with diabetes in the emergency department: the diabetic retinopathy screening in the emergency department (DRS-ED) study

BackgroundScreening for diabetic retinopathy (DR) is suboptimal, and patients with diabetes who present to the emergency department (ED) may be at particularly high risk of undiagnosed DR. The purpose of this study is to determine the prevalence of DR among diabetic patients who present to the ED of our tertiary medical center using teleophthalmology and to assess self-reported barriers to eye care.MethodsThis cross-sectional, single-institution study recruited clinically stable diabetic patients who presented to the ED during daytime hours over 29 total weekdays across 2 months in 2018 and 2019. Participants had nonmydriatic, 45-degree, single-field digital retinal photographs taken on site (Digital Retinal System, Centervue). Following retinal imaging, participants then completed a survey about barriers to regular eye care and their acceptance of potential interventions to promote screening. Digital retinal photographs were interpreted remotely by a board-certified ophthalmologist and communicated to participants’ primary care physician and/or endocrinologist.ResultsOver the study period, 275 ED patients had a documented diagnosis of diabetes, of whom 167 were deemed clinically stable for the study and 141 were invited to participate. Sixty-four were enrolled, of whom 50 had gradable-quality fundus images (78%). Of these 50 patients, almost all had type 2 diabetes (47, 94%), with an average disease duration of 12 ± 9 years and mean hemoglobin A1c of 8.1 ± 2.0% (mmol/mol). Based on fundus photography, 14 patients (28%) were diagnosed with DR, which was newly diagnosed for 10 (20% of the total study population). Severity was most commonly mild or moderate (12/14, 86%), with 1 case of severe nonproliferative DR and 1 proliferative DR. The majority (26, 52%) reported at least one barrier to routine eye care in our self-administered survey, of which having too many appointments (6, 12%) and cost (5, 10%) were frequently cited as most important. The majority were receptive to interventions to promote DR screening, including reminder phone calls (29, 58%) and text messages (28, 56%).ConclusionsDigital fundus photography in the ED detected a high rate of undiagnosed DR. Half of participants reported barriers to routine care, and most were receptive to messaging interventions to schedule an eye exam. Future studies are warranted to assess scalability of ED-based screening programs and their follow-through rates.

Periodic Eye Examinations among Ophthalmologists: Attitudes, Performance, and Barriers for Compliance

Background Preventive eye care is a preferred practice that includes recommended regular eye examinations, which is not always followed. Objective This study examined attitudes of ophthalmologists toward routine eye examinations, analyzed compliance with their own eye examinations, and described reasons for non-compliance. Methods This was a cross-sectional study involving an online survey, sent to all members of the Israeli Ophthalmological Society (IOS) asking their personal opinions concerning routine eye care, self-performance of these tests, and reasons for non-compliance. Results A total of 243 responses were received (59% males, mean age 52 years) representing 40% of IOS members. 98% of respondents think that adults should be routinely screened for eye diseases, most commonly annually (52%) or every two years (36%); however, only 55% of ophthalmologists reported having themselves a routine eye check in the past 3 years, which is significantly lower than their spouse (68%, P = 0.003). Recommendations for routine eye examinations were always higher than their actual performance regardless of the responding ophthalmologists’ gender, age or country of birth. Furthermore, female gender was found to be a negative predictor of having these examinations. Pupil dilation was performed in 38% of ophthalmologists’ testing, even though 80% of them think it is necessary for a complete examination. 'Lack of time' (35%) and 'forgetfulness' (31%) were the main reasons provided by ophthalmologists as an explanation for not having regular eye testing. Conclusions Ophthalmologists typically recognize the importance of preventive eye care, recommending periodic eye examinations for their patients; however, self-performance of these evaluations by the ophthalmologists themselves is much lower.

The effects of passive blinking on exposure keratopathy among patients in intensive care units

Background:Patients in Intensive Care Units (ICUs) are at risk of eye disorders such as Exposure keratopathy (EK) due to impaired blinking and incomplete eye closure. The aim of this study was to assess the effects of passive blinking exercise (PBE) on EK among patients in ICUs.Materials and Methods:This single-blind, randomized, clinical trial was conducted in 2017. The study participants included 51 patients purposively recruited from the three ICUs of Valiasr Teaching Hospital, Arak, Iran. Through coin tossing, one eye of each participant was randomly allocated to the intervention group and the other to the control group. The eye in the control group received routine eye care, whereas the eye in the intervention group received routine eye care and PBE for a week. EK prevalence and severity were assessed daily for 7 consecutive days using fluorescein eye staining papers and an ophthalmoscope with a cobalt blue filter.Results:The study groups did not significantly differ from each other in terms of the baseline prevalence and severity of EK. After the intervention, the prevalence of EK (χ2 = 13.44, df = 1, p < 0.001) and the prevalence of grade II EK (χ2 = 8.33, df = 1, p = 0.003) in the intervention group were significantly lower than the control group.Conclusions:PBE is effective in significantly reducing EK prevalence and severity among patients in ICUs. Therefore, critical care nurses are recommended to use PBE for EK prevention and management.

Eye care in intensive care in COVID-19 era: a prospective observational study from Turkey.

There has been an increase in intensive care applications due to respiratory failure of COVID-19 infection. Management of respiratory failure includes a range of additional interventions, including high-flow nasal oxygen, noninvasive and invasive ventilation and prone position. These interventions contain risk factors for the development of ocular complications. This study aimed to elucidate the ocular pathologies that occurred in COVID-19 patients hospitalized in the intensive care unit. Patients who completed 24 hours in the intensive care unit were included in the study. Age, gender, duration of hospitalization before intensive care unit, comorbid diseases and APACHE 2 scores of COVID-19 patients admitted to intensive care unit were recorded. SOFA scores, presence of sedation and muscle relaxant, oxygen therapy (conventional oxygen therapy, high flow nasal oxygen therapy, noninvasive ventilation, invasive ventilation) and presence of prone position were recorded. All patients were evaluated daily for ocular findings. Routine eye care protocol was applied to all patients. Seventy patients were followed for a total of 596 days in the intensive care unit. Pathological ocular findings were observed during hospitalization in 59 of the patients followed. The incidence of chemosis in patients who underwent IMV was significantly higher compared to other methods (p<0.001). In this study, we observed that despite our routine eye care protocols, invasive mechanical ventilation applications predispose corneal surface damage in patients followed up in the intensive care unit with COVID-19 infection.

Factors influencing the 8-item contact lens dry eye questionnaire score and comparison of translations in Japanese soft contact lens wearers

PurposeTo determine (1) the factors associated with a high degree of self-reported symptoms with Japanese translations of the 8-Item Contact Lens Dry Eye Questionnaire (J-CLDEQ-8) in a cross-section of soft contact lens (SCL) wearers in Japan and (2) whether the difference in translation of the CLDEQ-8 affects the scores between validated and non-validated versions of the Japanese translation. MethodsHabitual SCL wearers completed the validated J-CLDEQ-8 and a previous non-validated version. Demographics and SCL history questions were queried when they presented for routine eye care in nine geographically distinct clinics across Japan. The following risk factors for high J-CLDEQ-8 scores (≥11) were tested: sex, age, SCL replacement (daily disposable vs. bi-weekly and monthly reusable), years of SCL wear, and self-reported use of rewetting drops. The scores of the validated and non-validated questionnaires were compared. ResultsSignificant patient-related risk factors for high J-CLDEQ-8 scores were female sex, use of reusable SCLs, longer years of SCL wear, and use of rewetting drops. Scores for six out of eight questions in the validated J-CLDEQ-8 were significantly higher than those of the non-validated version, resulting in a significant difference in the average total score between the two questionnaires (validated J-CLDEQ-8: 10.5 ± 5.9 vs non-validated J-CLDEQ-8: 9.5 ± 5.8, P < 0.001). ConclusionsFemale sex, use of reusable SCLs, longer years of SCL wear, and use of rewetting drops were significant risk factors for high J-CLDEQ-8 scores in a cross-sectional clinical population of Japanese SCL wearers. Symptoms with SCL are not predicted by age and must therefore be queried at follow-up visits for all SCL wearers. Differences in the two translations affected the ability of the questionnaire to identify individuals with high symptoms associated with SCL wear.

The effect of implementation of evidence-based eye care protocol for patients in the intensive care units on superficial eye disorders

BackgroundSuperficial eye disorders are one of the most common complications of improper eye care in intensive care units that can lead to corneal ulcers and permanent eye damage. The aim of this study was to determine the effect of the implementation of eye care protocol on the incidence of infection and superficial eye disorders in patients admitted to intensive care units.MethodsThis study was a cross-over clinical trial that was performed on 32 patients admitted to the intensive care unit with reduced or no blink reflex following loss of consciousness or receiving sedatives. The eye of the test group received eye care according to the protocol and the eye of the control group received the routine care of the ward. The data collection form included demographic and clinical information and the clinical score scale of superficial eye disorders, which were completed in 7 days for both eyes. Data analysis was performed by McNemar and Cochran tests with a 95 % confidence interval.ResultsIn the study of superficial eye disorders, the frequency of dacryorrhea and hyperemia was not significantly different in the second to seventh days in the control and test eyes (P < 0.05). The frequency of xerophthalmia was not significantly different between the control and the test eyes on the second to third days (P < 0.05), but there was a significant difference on the fourth, fifth, sixth, and seventh days (P = 0.0001). Also, the frequency of corneal opacity was not significantly different in the second and third days (P < 0.05), but in the fourth (P < 0.05), fifth, sixth, and seventh days, this difference was significant (P = 0.0001).ConclusionsBased on the results, although the implementation of eye care protocol has been able to have a significant effect on reducing ocular complications and problems, routine eye care in the intensive care unit also has clinical effectiveness. Therefore, in order to prevent and completely eliminate eye disorders in the intensive care unit, more evidence and research are needed.Trial registrationThe trial was retrospectively registered on https://en.irct.ir/trial/43493 on 13 November 2019 (13.11.2019) with registration number [IRCT20140307016870N5].

A New Development of the Medical lnformation Management for the Treatment of Retinal Vascular Occlusions

Retinal vascular occlusions are an emergency disease of ophthalmology that causes blood vessels in the eye to block or burst, causing vision loss or blindness. Therefore, this study attempts to develop new medical information management to treat retinal vascular occlusion. The data were surveyed on 122 people who visited the ophthalmologist from May 6 to July 10, 2019. The survey was conducted by classifying 61 test respondents who mediated the information management and 61 comparative respondents who did not mediated. The basic information of participants was provided using the X2 test. The approach for preventing retinal vascular occlusion before and after information management application was analyzed as t-test. A comparative analysis of overall eye conditions was performed with t-test. The participants’ practice of eye health was analyzed with t-test. Findings: The derived data present the following. (1) The blinking eyes inner canthus were significantly higher after the attempt than before management (t = −5.83, p = .000). (2) The acupressure around the eyes was significantly higher 43.62% after the management attempt, compared to the 14.93% before the attempt (t = −3.47, p = .000). (3) The eye movement was significantly higher after the attempt than before the attempt (t = −1.08, p = .000). (4) Renal vessel has been confirmed that the retinal vessel is also improving significantly after care than before (p &lt; .05). (5) In particular, retinal blood vessels have improved significantly since the 18th. However, since the 22nd, retinal blood vessels have shown a slight decrease. The above findings pointed out that retinal vascular occlusion requires routine eye care. Therefore, this study found that medical information management applied to the experiment was effective in preventing retinal vascular occlusion.

Visual Status in a Portuguese Population with Intellectual Disability.

Background: Neurosensory deprivation associated with vision is a well-known fact in people with intellectual disability (ID). This work aims to report the visual status of a population with ID in Portugal. Methods: A vision screening protocol was conducted during two Special Olympics events. The vision protocol included personal medical history, ocular health evaluation, and clinical measures, such as visual acuity (VA), binocular vision, colour vision, refractive error, and intraocular pressure. This protocol was administered to 134 subjects. Results: Half of the subjects reported that they had never attended or they did not remember having attended a previous eye exam. Additionally, 10% of them had not attended an eye exam in the immediate past three years. Half the subjects failed the VA test and 13% presented moderate Visual Impairment (VI) (VA worse than 0.5 logMAR in the best eye). Manifest ocular deviation was found in 25% of the subjects and the most common ocular health dysfunction conditions were conjunctiva hyperaemia, meibomian gland dysfunction, and lens anomalies. Refractive error correction allowed a reduction in the level of moderate VI to 3.7%. Conclusions: The population analysed showed a poor eye care attendance rate and vision-related conditions are in agreement with previous reports. The development of national strategies to promote the awareness for routine eye care in people with ID and improving accessibility to eye care services may mitigate many of the most prevalent conditions encountered.

Ocular Surface Disease in a PICU: Incidence and Outcomes With a Dynamic Eye Care Protocol.

Sedated intensive care patients have impaired ocular protective mechanisms putting them at risk for ocular surface disease with potential vision loss. Historically, routine eye care has been limited to critically ill patients receiving neuromuscular blockade. The aim of this project was to determine the occurrence rate of ocular surface disease in sedated and ventilated children, identify risk factors, and determine the progression of injury with routine eye care. Prospective cohort study. A tertiary care medical-surgical PICU. All intubated patients admitted from May 2015 to December 2016. Staff education regarding corneal examination with fluorescein, and routine eye care as per a PICU eye care protocol. We evaluated 479 patients (1,242 corneal exams) and found that 15% had ocular surface disease at admission to the PICU: keratopathy 62, abrasion 16. The highest incidence was in trauma patients (39.0%) and those intubated in the emergency department (22.2%) or prehospital setting (42.9%). Of the 245 patients with multiple ocular assessments, 32.2% displayed ocular surface disease at some point during their hospitalization: keratopathy 73, abrasion 24. Ourprotocol dictated increased frequency of eye care if ocular surface disease worsened. As a result, the overall incidence of ocular surface disease decreased to 8.6% by the last examination (keratopathy 19, mild abrasion 2), but more severe ocular abnormalities such as corneal infiltrates, ulcers, or scarring were not observed. Based on multivariate analysis, clinical factors associated with increased risk of ocular surface disease included primary diagnosis, and lagophthalmos (incomplete eyelid closure). Ocular surface disease is an under-recognized process in critically ill pediatric patients. A standardized and dynamic protocol may improve corneal health, which in turn may reduce injury, pain, infection, and long-term vision loss.

Community Health Centers: A Model for Integrating Eye Care Services with the Practice of Primary Care Medicine.

Optometry is desperately needed to combat the increasing rate of avoidable visual impairment that goes undiagnosed largely owing to the lack of integration of eye care services with primary care medicine. Government leaders are actively discussing substantive changes to health care legislation that will impact optometrists and their patients. The importance of a regular eye examination for disease prevention has long been undervalued in the setting of primary care. Consequently, many serious and potentially treatable ocular and systemic diseases go undiagnosed. Despite clear indicators that vision impairment increases the risk of morbidity and mortality from chronic systemic disease and decreases quality of life, vision health remains among the greatest unmet health care needs in the United States. To improve vision care services for all Americans, we must focus our attention on two central themes. First, we must educate the public, health care professionals, and policymakers on the importance of routine eye care as a preventive measure in the setting of primary care. Next, we need to recognize that optometrists, through their geographic distribution and advanced training, are in a strategic position to deliver integrated, comprehensive, cost-effective eye care services for individuals most in need. In this perspective, we discuss a model for integrating optometric services with the practice of primary care medicine to facilitate early detection of both eye and systemic disease while reducing serious and preventable health-related consequences.