Vision Services Research Articles

Service providers views on changes in low vision service provision during and after the COVID-19 pandemic

The COVID-19 pandemic resulted in changes to low vision service provision across the UK. The main aim of this study was to investigate service providers’ (SPs) experiences of, and views on, the impact of the COVID-19 pandemic on provision of low vision (LV) assessments, and future provision post-pandemic. A mixed methods approach employed two surveys (S1 and S2) and one-to-one semi-structured phone interviews. SPs were invited for S1 (LV assessments before and during the pandemic) between June and August 2021, and S2 (post-pandemic services) in July 2022. Eleven purposively recruited SPs gave telephone interviews, assessing changes to LV assessments during the pandemic and how experiences could inform future services. Survey responses were tested for significant differences between proportions, and interviews analysed using thematic analysis. Eighty SPs, comprising clinical and non-clinical professionals, responded to S1, 27 to S2. Two themes emerged from interviews and surveys: early pandemic modifications and remote services. From S1, during the pandemic there was a significant increase ( p < .001) in the proportion of SPs providing LV assessments remotely (either alongside face-to-face provision, or remotely only), compared with pre-pandemic. S1, conducted while some COVID restrictions remained, also identified an increase in the proportion of LV assessments expected to be provided remotely post-pandemic compared with pre-pandemic ( p < .001). However, for S2, conducted after all restrictions were lifted, the increase in the proportion of LV assessments actually provided remotely post-pandemic was not statistically significant ( p = .20). Advantages (e.g., reduced risk of infection) and limitations (e.g., issues for hearing-impaired users) of remote LV assessments were highlighted. Remote LV assessments increased significantly during the pandemic and remained more common post- than pre-pandemic, though less common than anticipated. Many advantages were perceived, but guidance may need to be developed before remote services are more widely adopted.

Diagnosis and Care of Children With Cerebral/Cortical Visual Impairment: Clinical Report.

Cerebral/cortical visual impairment (CVI) is a leading cause of pediatric visual impairment in nations with developed economies and is increasing in those with developing economies. Because vision is the predominant sense used for learning, delay in diagnosis of CVI can negatively affect education, making early detection and management important. The American Academy of Pediatrics has published the policy statement "Visual System Assessment in Infants, Children, and Young Adults by Pediatricians" and an accompanying clinical report that are based on identifying potential causes of ocular visual impairment in children. Yet, routine vision screening may not accurately identify the brain-based visual impairment in children with CVI. Moreover, children with CVI often have medical complexity with other neurocognitive impairments and serious medical conditions that can make the diagnosis of CVI more difficult. Strategies are necessary for early identification of CVI to promote early diagnosis and referral for vision services that may allow a child with CVI to engage more fully in school, activities of daily living, vocational pursuits, and recreational activities. Knowledge of the characteristics of CVI as well as risk factors for CVI will assist the pediatrician in identifying children with CVI. This clinical report is complementary to previous vision screening policies, allowing both ocular and brain-based visual impairments in children to be identified and addressed. Pediatricians, other primary care physicians, pediatric ophthalmologists, neurologists, and other specialized pediatric eye care clinicians can identify children with CVI and coordinate effective evaluation, diagnosis, and referrals for vision services for these children.

Is the delivery of National Disability Insurance Scheme in Australia through quasi markets achieving the right outcomes in vision rehabilitation services? A qualitative study

Purpose Despite being a pioneering social initiative worldwide, Australia’s National Disability Insurance Scheme (NDIS) still presents unresolved issues for individuals with vision-related disability regarding its processes and outcomes. This study evaluates how well the NDIS markets are perceived to achieve efficiency, responsiveness, choice, quality, and equity within the vision rehabilitation sector, and identified factors facilitating or hindering desired outcomes. Materials and methods This qualitative study conducted 22 semi-structured interviews involving individuals with vision disability, service providers, peak-body and professional-body representatives, and an NDIS planner. Results Findings across stakeholder groups show minimal variation. The NDIS’s quasi-market approach has improved participants’ choices over ways to utilise and manage their funding and consequently provided them with a sense of control and empowerment. However, inefficiencies persist due to insufficient competition, workforce shortages, price caps, information asymmetry, high transaction costs, gaming behaviour, inadequate staff training, complex and lengthy processes, and eligibility concerns. Supportive factors include effective advocacy, pragmatic regulations to maintain quality, opportunities for innovation, and service providers’ motivation for cost-effectiveness. Conclusions While NDIS markets have made significant strides in enhancing participants’ choice and control, our findings underscore the need for continued refinement to achieve broader social objectives and long-term sustainability for individuals with vision-related disability.

Designing and Implementing a Public Urban Transport Scheduling System Based on Artificial Intelligence for Smart Cities

Many countries encourage their populations to use public urban transport to decrease pollution and traffic congestion. However, this can generate overcrowded routes at certain times and low economic efficiency for public urban transport companies when buses carry few passengers. This article proposes a Public Urban Transport Scheduling System (PUTSS) algorithm for allocating a public urban transport fleet based on the number of passengers waiting for a bus and considering the efficiency of public urban transport companies. The PUTSS algorithm integrates artificial intelligence (AI) methods to identify the number of people waiting at each station through real-time image acquisition. The technique presented is Azure Computer Vision. In a case study, the accuracy of correctly identifying the number of persons in an image was computed using the Microsoft Azure Computer Vision service. The proposed PUTSS algorithm also uses Google Maps Service for congestion-level identification. Employing these modern tools in the algorithm makes improving public urban transport services possible. The algorithm is integrated into a software application developed in C#, simulating a real-world scenario involving two public urban transport vehicles. The global accuracy rate of 89.81% demonstrates the practical applicability of the software product.

Assessment of visual impairment and need of rehabilitation services for children attending schools for blind in an urban city of North India.

By understanding the prevalence and causes of childhood blindness, stakeholders can work toward comprehensive strategies that encompass prevention, treatment, rehabilitation, and support, ultimately improving the quality of life for affected children. The information about the pattern and causes of childhood blindness in Northern Indian states is limited, it highlights the need for further research and data collection to better understand and address the specific challenges in this region. Therefore, the present cross-sectional study was planned to ascertain the different causes and patterns of childhood blindness and to understand the barriers to the use of LVAs and its compliance among the students attending schools for the blind in a North Indian State. Students from two schools for blind were examined in Chandigarh and its vicinity in North India. The different causes of severe visual impairment/blindness were classified as per the World Health Organization/Prevention of Blindness standard recording form. A total of 89 students attending schools for the blind were examined. The mean age was 13.10 years (range = 4-16 years). Male, female ratio was 3.3:1. The major causes of blindness were congenital anomalies (whole globe anomalies 37.08%), followed by retinal conditions (16.7 = 8%), undetermined/other (12.3), and lenticular conditions (112%). More than one-third of children (34.8%) were blind due to avoidable causes of blindness. The current study data append on the existing national available data about childhood blindness in India. Though the sample size of the current is comparatively low, observed different results as compared to previously published reports from other regions, emphasize the strengthening of pediatric ophthalmology services as well as of low vision services in this particular region of North India.

The multiple mediating effects of vision-specific factors and depression on the association between visual impairment severity and fatigue: a path analysis study

BackgroundSevere fatigue is a common symptom for people with visual impairment, with a detrimental effect on emotional functioning, cognition, work capacity and activities of daily living. A previous study found that depression was one of the most important determinants of fatigue, but less is known about disease-specific factors in this patient population. This study aimed to explore the association between visual impairment severity and fatigue in adults with low vision, both directly and indirectly, with vision-specific factors and depression as potential mediators.MethodsCross-sectional data were collected from 220 Dutch low vision service patients by telephone interviews. Fatigue was defined as a latent variable by severity and impact on daily life. Potential mediators included vision-related symptoms, adaptation to vision loss and depression. Hypothesized structural equation models were constructed in Mplus to test (in)direct effects of visual impairment severity (mild/moderate, severe, blindness) on fatigue through above mentioned variables.ResultsThe final model explained 60% of fatigue variance and revealed a significant total effect of visual impairment severity on fatigue. Patients with severe visual impairment (reference group) had significantly higher fatigue symptoms compared to those with mild/moderate visual impairment (β = -0.50, 95% bias-corrected confidence interval [BC CI] [-0.86, -0.16]) and those with blindness (β = -0.44, 95% BC CI [-0.80, -0.07]). Eye strain & light disturbance, depression and vision-related mobility mediated the fatigue difference between the severe and mild/moderate visual impairment categories. The fatigue difference between the severe visual impairment and blindness categories was solely explained by eye strain & light disturbance. Moreover, depressive symptoms (β = 0.65, p < 0.001) and eye strain & light disturbance (β = 0.19, p = 0.023) were directly associated with fatigue independent of visual impairment severity.ConclusionsOur findings indicate an inverted-U shaped relationship between visual impairment severity and fatigue in patients with low vision. The complexity of this relationship is likely explained by the consequences of visual impairment, in particular by strained eyes and depressive mood, rather than by severity of the disability itself.

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.

The Role Of Social Workers In Low Vision Rehabilitation Services At The Worth Foundation

Low vision is a form of visual impairment that limits daily activities and cannot be corrected with glasses, contact lenses, medication, or surgery (Jennifer Hissett 2008, 1032-33). Social workers have unique abilities in carrying out their role as professional experts in implementing low vision services at LAYAK Foundation's. One of the social institutions in Jakarta that participates in the implementation of social welfare that raises the issue of low vision is Yayasan Pelayanan Anak dan Keluarga (LAYAK). So the researcher wants to see what role social workers can play in helping low vision disabilities overcome limitations through the LAYAK Foundation's rehabilitation services. Research using qualitative methods using observation techniques, interviews and also using documentation studies, researchers focus the problem on the role of social workers carried out in rehabilitation services at LAYAK Foundation. Based on Walter A Fridlander's theory, the role of social workers is divided into 7 roles, namely as a catalyst, informator, mediator, motivator, counselor, facilitator and educator. In the research findings, it can be concluded that the role of social workers in increasing client independence in rehabilitation services at the LAYAK Foundation has advantages and disadvantages.

Underserved groups could be better considered within population-based eye health surveys: a methodological study

ObjectivesIn pursuit of health equity, the World Health Organization has recently called for more extensive monitoring of inequalities in eye health. Population-based eye health surveys can provide this information, but whether underserved groups are considered in the design, implementation, and reporting of surveys is unknown. We conducted a systematic methodological review of surveys published since 2000 to examine how many population-based eye health surveys have considered underserved groups in their design, implementation, or reporting. Study Design and SettingWe identified all population-based cross-sectional surveys reporting the prevalence of objectively measured vision impairment or blindness. Using the PROGRESS + framework to identify underserved groups, we assessed whether each study considered underserved groups within 15 items across the rationale, sampling or recruitment methods, or the reporting of participation and prevalence rates. Results388 eye health surveys were included in this review. Few studies prospectively considered underserved groups during study planning or implementation, for example within their sample size calculations (n = 5, ∼1%) or recruitment strategies (n = 70, 18%). The most common way that studies considered underserved groups was in the reporting of prevalence estimates (n = 374, 96%). We observed a modest increase in the number of distinct PROGRESS + factors considered by a publication over the study period. Gender/sex was considered within at least one item by 95% (n = 367) of studies. Forty-three percent (n = 166) of included studies were conducted primarily on underserved population groups, particularly for subnational studies of people living in rural areas, and we identified examples of robust population-based studies in socially excluded groups. ConclusionMore effort is needed to improve the design, implementation, and reporting of surveys to monitor inequality and promote equity in eye health. Ideally, national-level monitoring of vision impairment and service coverage would be supplemented with smaller-scale studies to understand the disparities experienced by the most underserved groups.

Low vision aids provision in an urban setting in Germany between 2014 and 2017: a regional population based study with healthcare claims data

PurposeLittle is known about the utilization of low vision services (LVS) in Germany. To understand which persons and how often these services would be utilized, this study aimed to investigate low vision aids (LVAs) provision in an urban setting and to describe user characteristics and trends in their characteristics.MethodsA retrospective study based on a population-based healthcare claims database in Cologne (N = ~ 500,000), Germany. The study population comprised individuals, who were continuously insured at four large statutory health insurers and who redeemed a prescription for visual aids or aids for blindness between January 2014 and December 2017. We examined their socio-demographic and clinical characteristics. Trends in characteristics were examined with logistic and linear regression models over time.ResultsOut of ~ 500,000 persons, 781 unique individuals (~ 0.2%) redeemed an LVA prescription. They were mainly female (68.7%), 60 years or older (75.3%) and had macular degeneration (50.6%) and/or glaucoma (25.9%). In the working-age subgroup, 33.8% were employed. Visual aids were most often prescribed (74.1%) and of all types of LVAs, individuals most commonly redeemed a prescription for magnifiers (35.8%), screen readers (34.3%) and/or canes (17.1%). Of the entire study population, 75.4% received their prescription from an ophthalmologist, 5.3% from a general practitioner and 7.1% from other medical specialists. Significant trends in characteristics of individuals who redeemed an LVA prescription were not found.ConclusionsBetween 2014 and 2017, 781 individuals in Cologne redeemed an LVA prescription. They had characteristics which mostly can be explained by the epidemiology of VI. Results indicate that individuals that redeemed LVAs have a magnification requirement of ≥ 1.5-fold and ≥ 6-fold. Furthermore, next to ophthalmologists, general practitioners and other medical specialists seem to play a role in LVA provision as well, which should be taken into account by policy makers when planning interventions for increasing LVS provision. Our findings provide a starting point to examine LVS provision in Germany.

Access to low vision rehabilitation services in Australia: practitioner perspective

ABSTRACT Clinical relevance The burden of vision loss is both personal and economic. Having reduced vision can restrict access to education, job opportunities, and other activities, and patients can require substantial government funds for treatment and rehabilitation. An in-depth investigation of barriers and enablers is required to improve access to low vision rehabilitation services. Background Several clinical trials have demonstrated the effectiveness of low vision rehabilitation services, leading to improved clinical and functional abilities. However not all patients make use of these resources. Methods A purposive sample of primary eyecare practitioners (optometrists and orthoptists who held a variety of roles in clinical practice, academia and low vision specific organisations) were invited to participate in focus groups that were audio-recorded and transcribed verbatim. The resulting data were de-identified, cleaned, independently coded by two researchers and compared. Data were analysed using an interpretative phenomenological approach that included inductive thematic analysis. Results Of the 21 practitioners attending the five focus groups, 67% were female and 33% were male. The participants were optometrists and orthoptists with a wide range (4 to 20+ years) of clinical experience in eyecare service delivery. Four major themes emerged from the analysis: three themes focus on identifying barriers, while one theme highlighted potential enablers. These themes encompassed barriers impacting referral frequency, practitioner knowledge, patient experience, and enablers that suggest improvement options for enhancing low vision services. Conclusion Miscommunication between service providers, miscommunication between patients and clinicians, late referral, cost of services and social stigma were major barriers preventing patients from receiving low vision services. Most practitioners admitted limited knowledge of the scope of services provided by low vision organisations, suggesting there is a need for enablers such as professional development, improved communication between service providers, enhanced referral guidelines and increased public awareness.

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.

Big data study using health insurance claims to predict multidisciplinary low vision service uptake.

There is a lack of research from high-income countries with various health care and funding systems regarding barriers and facilitators in low vision services (LVS) access. Furthermore, very few studies on LVS provision have used claims data. This study aimed to investigate which patient characteristics predict receiving multidisciplinary LVS (MLVS) in the Netherlands, a high-income country, based on health care claims data. Data from a Dutch national health insurance claims database (2015 to 2018) of patients with eye diseases causing potentially severe visual impairment were retrieved. Patients received MLVS (n = 8766) and/or ophthalmic treatment in 2018 (reference, n = 565,496). MLVS is provided by professionals from various clinical backgrounds, including nonprofit low vision optometry. Patient characteristics (sociodemographic, clinical, contextual, general health care utilization) were assessed as potential predictors using a multivariable logistic regression model, which was internally validated with bootstrapping. Predictors for receiving MLVS included prescription of low vision aids (odds ratio [OR], 8.76; 95% confidence interval [CI], 7.99 to 9.61), having multiple ophthalmic diagnoses (OR, 3.49; 95% CI, 3.30 to 3.70), receiving occupational therapy (OR, 2.32; 95% CI, 2.15 to 2.51), mental comorbidity (OR, 1.17; 95% CI, 1.10 to 1.23), comorbid hearing disorder (OR, 1.98; 95% CI, 1.86 to 2.11), and receiving treatment in both a general hospital and a specialized ophthalmic center (OR, 1.23; 95% CI, 1.10 to 1.37), or by a general practitioner (OR, 1.23; 95% CI, 1.18 to 1.29). Characteristics associated with lower odds included older age (OR, 0.30; 95% CI, 0.28 to 0.32), having a low social economic status (OR, 0.91; 95% CI, 0.86 to 0.97), physical comorbidity (OR, 0.87; 95% CI, 0.82 to 0.92), and greater distance to an MLVS (OR, 0.95; 95% CI, 0.92 to 0.98). The area under the curve of the model was 0.75 (95% CI, 0.75 to 0.76; optimism = 0.0008). Various sociodemographic, clinical, and contextual patient characteristics, as well as factors related to patients' general health care utilization, were found to influence MLVS receipt as barriers or facilitators. Eye care practitioners should have attention for socioeconomically disadvantaged older patients when considering MLVS referral.

Confidence in low vision rehabilitation and attitudes towards further learning: A survey of UK optometrists.

Optometrists are well positioned to help expand low vision (LV) services and improve their availability and accessibility. Determinants of participation in LV service provision must be well understood to facilitate successful service expansion. This survey aimed to investigate optometrists' professional confidence in the delivery of LV services and attitudes towards further learning. An online survey was emailed to a sample of College of Optometrists members. Respondents rated their confidence in different areas of core optometric practice; confidence in LV was compared with confidence in other areas. Respondents also rated their confidence in undertaking multiple tasks involved in LV service delivery and in routine optometric practice; confidence was compared between optometrists who do and do not work in a LV service. Attitudes towards learning more about assessing and supporting patients with a vision impairment (VI) were recorded. The survey received 451 recorded responses (15.1% response rate). Optometrists who do not work in a LV service reported significantly lower confidence in LV than in other areas of core optometric practice, whereas optometrists who work in a LV service reported significantly higher confidence in LV than in other areas. Additionally, optometrists who do not work in a LV service reported significantly lower confidence in all tasks involved in LV service delivery than optometrists who work in a LV service (p < 0.001 for all tasks). Approximately 80% of respondents were interested in learning more about assessing and supporting patients with a VI. Optometrists who do not work in a LV service have relatively low confidence in LV, which could contribute to low motivation to participate in LV service provision. There is sizeable interest in learning more about assessing and supporting patients with a VI, which could help to increase motivation to participate in LV service provision.

Eye Care in Federally Qualified Health Centers

PurposeTo understand the availability of vision care provided within Federally Qualified Health Centers (FQHCs) in 2017 versus 2021, and to assess whether differences exist in neighborhood-level demographic factors and social risk factors (SRFs) between FQHCs based on the availability of eye care services. DesignSecondary data analysis of the Health Resources and Services Administration (HRSA) FQHC data and 2017-2021 American Community Survey neighborhood SRFs. ParticipantsFQHCs in 2017 and 2021. MethodsPatient and neighborhood characteristics for each SRF were summarized. Differences in FQHCs providing and not providing vision care were compared via Wilcoxon Mann–Whitney tests for continuous measures and chi-square tests for categorical measures. Logistic regression models were used to test the associations between neighborhood measures and FQHCs providing vision care, adjusted for patient characteristics. Main Outcome MeasuresOdds ratios (ORs) with 95% confidence intervals for neighborhood-level predictors of FQHCs providing vision care services. ResultsOverall, 28.5% of FQHCs (n=375/1318) provided vision care in 2017 vs. 32% (n=435/1362) in 2021 with some increases and decreases in both the number of FQHCs and those with and without vision services. Only 2.6% of people who accessed FQHC services received eye care in 2021. Among the 435 FQHCs that provided vision care in 2021, 27.1% (n=118) had added vision services between 2017 and 2021, 71.5% (n=311) had been offering vision services since at least 2017, and 1.4% were newly established. Logistic regression models demonstrated FQHCs providing vision care in 2021 were more likely to be in neighborhoods with higher percentage of Hispanic/Latino individuals (OR=1.08, 95% CI=1.02-1.14, p=0.0094), Medicaid-insured individuals (OR=1.08, 95% CI=1.02-1.14, p=0.0120), and no car households (OR=1.07, 95% CI=1.01-1.13, p=0.0142). However, FQHCs with vision care, compared to FQHCs without vision care, served a lower percentage of Hispanic/Latino individuals (27.2% vs. 33.9%, p=0.0007), Medicaid-insured patients (42.8% vs. 46.8%, p<0.0001), and patients living at/below 100% of the federal poverty line (61.3% vs. 66.3%, p<0.0001). ConclusionsVision care services are available at few FQHCs, localized to a few states. Expanding access to eye care at FQHCs would meet patients where they seek care to mitigate vision loss to underserved communities.

Dwells in museum: The restorative potential of augmented reality

Augmented Reality (AR) is increasingly recognized as a transformative tool for creating restorative environments within museums. It has the potential to provide psychological benefits for visitors, including attention restoration, stress reduction, and anxiety alleviation. This study explores how AR can foster these benefits within museum spaces. By adopting AR technology, museums can go beyond their traditional roles of knowledge dissemination. The immersive, adaptive, and interactive features of AR can enhance the museum experience, transforming it into an innovative therapeutic space. By combining real exhibits with virtual elements, AR can restore visitors’ psychological energy within museum settings. This integration of digital innovation into restorative contexts surpasses the traditional functions of visual service. Through empirical investigation of multiple dimensions of restorative environments, AR museum experiences offer comprehensive attention restoration. In this study, a survey was conducted with 279 participants to assess the impact of AR museum experiences on visitors’ psychology. The results revealed that such experiences contribute to heightened attention restoration levels, stress reduction, and anxiety relief. With the latest advancements in generative artificial intelligence, AR technology is empowered to integrate within museums. This integration will merge individuals with customized technology, expanding human perceptual experiences and highlighting AR's significant influence within the museum environment.

Ophthalmic Nursing in Specialized Healthcare

In health care settings, due to advancement in technologies, the expectations from every individual have increased over the last few years. Advance nursing educational programs &amp; trainings are developing competency of nurses in every specialized area. Consequently the nurses need to enhance practical skills to meet the expectations of the patient. Nurses have upgraded standard of nursing care both in community health &amp; hospital based health care settings. Specialized ophthalmic nurse plays significant role regarding promotion of eye health, preventive &amp; curative treatment of eye disease as well as for low vision services &amp; rehabilitation. In challenging situation to meet the growing needs of ophthalmic profession, modern ophthalmic nurse is frequently encountered with expectations to deal more patients, more swiftly by using specialized ophthalmic skills &amp; new technology to meet the goals regarding eye health and wellbeing of the patients. This advanced specialized skill enables ophthalmic nurses to expand their practices in different areas of ophthalmic care. Nurses are more vigilant to deal emergencies especially in areas where the resources are minimum and burden of patients. In tertiary eye hospitals nurses perform administrative duties very efficiently as well as clinical duties. An ophthalmic nurse can assess visually impaired patient. They also helps to meet the psychological or spiritual needs of the patient. They can educate and counsel patient which plays a significant role in increasing the awareness of visually impaired.

The Use of Mobile Medical Units for Populations Experiencing Homelessness in the United States: A Scoping Review.

With annual point-in-time counts indicating a rise in unsheltered homelessness in the United States, much attention has been paid to how to best provide care to this population. Mobile medical units (MMUs) have been utilized by many programs. However, little is known regarding the evidence behind their effectiveness. A scoping review is conducted of research on MMU provision of medical services for populations experiencing homelessness in the USA to examine the extent and nature of research activity, summarize available evidence, and identify research gaps in the existing literature. Following guidelines for scoping reviews, PubMed and Google Scholar were used to identify an initial 294 papers published from January 1, 1980, to May 1, 2023, using selected keywords, which were distilled to a final set of 50 studies that met eligibility criteria. Eligible articles were defined as those that pertain to the provision of healthcare (inclusive of dental, vision, and specialty services) to populations experiencing homelessness through a MMU in the United States and have been published after peer review. Of the 50 studies in the review, the majority utilized descriptive (40%) or observational methods (36%), with 4 review and 8 controlled studies and no completed randomized controlled trials. Outcome measures utilized by studies include MMU services provided (58%), patient demographics (34%), health outcomes (16%), patient-centered measures (14%), healthcare utilization (10%) and cost analysis (6%). The studies that exist suggest MMUs can facilitate effective treatment of substance use disorders, provision of primary care, and services for severe mental illness among people experiencing homelessness. MMUs have potential to provide community-based healthcare services in settings where homeless populations reside, but the paucity of randomized controlled trials indicates further research is needed to understand if MMUs are more effective than other care delivery models tailored to populations experiencing homelessness.

A retrospective big data study using healthcare insurance claims to investigate the role of comorbidities in receiving low vision services.

The aim was to examine the association between physical and mental comorbidity with receiving low vision services (LVS). A retrospective study based on Dutch claims data of health insurers was performed. We retrieved data (2015-2018) of patients (≥18 years) with eye diseases causing severe vision loss who received LVS at Dutch rehabilitation organizations in 2018 (target group) and patients who did not receive LVS, but who received ophthalmic medical specialist care for glaucoma, macular, diabetic retinal and/or retinal diseases in 2018 (reference group). For examining the association between the patients' comorbidities and receiving LVS, multivariable logistic regression was used. The relative quality of five different models was assessed with the Akaike Information Criterion (AIC). The study population consisted of 574,262 patients, of which 8,766 in the target group and 565,496 in the reference group. Physical comorbidity was found in 83% and 14% had mental comorbidity. After adjustment for all assumed confounders, both physical and mental comorbidity remained significantly associated with receiving LVS. In the adjusted model, which also included both comorbidity variables, the best relative quality was found to describe the association between mental and physical comorbidity and receiving LVS. Mental comorbidity seemed to be independently associated with receiving LVS, implying that the odds for receiving a LVS referral are higher in patients who are vulnerable to mental comorbidity. Physical comorbidity was independently associated, however, the association with receiving LVS might not be that meaningful in terms of policy implications. Providing mental healthcare interventions for people with VI seems warranted.

Low Vision Practice and Service Provision Among Optometrists in Ghana: A Nationwide Survey

ABSTRACT Purpose To characterize practice patterns of low vision services among Optometrists in Ghana. Methods The nationwide cross-sectional survey identified entities through the Ghana Optometrists Association (GOA) registry and utilized a semi-structured questionnaire to consolidate survey information that comprises practitioners’ demographics, available services, diagnostic equipment, barriers to service provision and utilization, and interventions. Results 300 Optometrists were identified, with 213 surveyed (71% response rate). About fifty percent (52.6%) were in private practice, and more than two-thirds (77%) did not provide low vision services. Most (≥70%) reported lack of assistive devices, and basic eye care examination kits as the main barriers to low vision service provision. Similarly, practitioners reported unawareness of the presence of low vision centres (76.1%), and high cost of low vision aids (75.1%) as the prime perceived barriers for patients to utilize low vision services. Continuous professional development and public education (89–90%) were suggested as interventions to improve the uptake of low vision services. After statistical adjustment, private facility type (Adjusted odds ratio [AOR] = 0.35, p = 0.010) and lack of basic eye examination kits (AOR = 0.32, p = 0.002) were significantly associated with reduced odds of low vision service provision. Conversely, ≥15 years of work experience (AOR = 6.37, p = 0.011) was significantly associated with increased odds of low vision service provision. Conclusions Overall, the results indicate inadequate low vision coverage and service delivery. Government policies must be directed towards equipping practitioners with equipment and subsidize patient cost of treatment to optimize low vision care.