Refractive error, risk of amblyopia and eye care services utilisation among Nunavik Inuit in Northern Canada.

CLINICAL RELEVANCE: Nunavik Inuit patients, in Northern Canada, have a significant burden of refractive error. The frequency at which they access eye care is insufficient. This exposes children of this population to a substantial risk of refractive amblyopia. BACKGROUND: No data are available on eye health and services among Nunavik Inuit in Quebec, Canada. This study aims to describe the prevalence of ametropias, risk of refractive amblyopia, and eye health services uptake amongst a sample of Nunavik Inuit. METHODS: Retrospective cohort using data from electronic records of the sole government-contracted eye team travelling to all 14 Nunavik villages, from 2006 to 2018. RESULTS: Some 26,541 examinations were analysed, with data from 6,341 patients (median age 27 years (IQR 30); 32% aged under 19 years; 60.3% female) representing 48% of the census population. Population weighted prevalence of ametropias was myopia 46.5% (95% CI 45.3 - 47.6), hyperopia 17.1% (95% CI 16.2 - 18.1), astigmatism 39.6% (95% CI 38.4 - 40.8) and presbyopia 30.0% (95% CI 28.9 - 31.0). Some 5.9% of patients aged 0-9 years present a risk of refractive amblyopia. Mean frequency of examinations for all ages was once per 4 years (95% CI 4.0 - 4.0) and for children aged 5 - 19 years, frequency was once per 4.8 years (95% CI 4.8 - 5.0). In 2018, 74% of patients who were prescribed spectacles purchased them, with a median time of procurement of 21 days (IQR 247, skewness 2.7). CONCLUSION: There is a high prevalence of ametropias amongst the clinical population of Nunavik Inuit. Most patients needing spectacles obtain them within a few weeks. Frequency of eye health services is insufficient to meet recommended guidelines, especially in children, for whom the risk of refractive amblyopia is pervasive.

State of the eye health system in the Pacific: is medical technology available and used by mid-level eye care workers?

INTRODUCTION: The aim of this study is to describe the availability, use and comfort with ophthalmic equipment and medications by mid-level eye care workers in Papua New Guinea and Pacific Island countries and territories as indicators of the state of eye care in the Pacific. METHODS: Health information system data, from a workforce support program to Pacific mid-level eye care workers, were analysed for availability and comfort with use of ophthalmic equipment and topical medications. RESULTS: For refraction equipment, access was excellent (98% for retinoscopes and trial lenses) 'very frequent use' range was 42-74% and 'high comfort of use' range was 54-86%. Equipment for ocular health assessment is widely available (slit lamps 67%), with high comfort levels (78-100% 'very comfortable'). Over 70% of respondents have access to topical diagnostic medications, 98% have access to at least one type of antibiotic drops and 63% have access to at least one topical corticosteroid. CONCLUSION: Overall, trained mid-level eye care workers in the Pacific seem well equipped for ocular health and refractive assessments. Comfort levels are encouraging, but also highlight areas for continuing professional development. Access to ophthalmic medications appears acceptable in the region for low morbidity anterior segment conditions.

Age Affects How Task Difficulty and Complexity Modulate Perceptual Decision-Making.

Decisions differ in difficulty and rely on perceptual information that varies in richness (complexity); aging affects cognitive function including decision-making, and yet, the interaction between difficulty and perceptual complexity have rarely been addressed in aging. Using a parametric fMRI modulation analysis and psychophysics, we address how task difficulty affects decision-making when controlling for the complexity of the perceptual context in which decisions are made. Perceptual complexity was varied in a factorial design while participants made perceptual judgments on the spatial frequency of two patches that either shared the same orientation (simple condition) or were orthogonal in orientation (complex condition). Psychophysical thresholds were measured for each participant in each condition and served to set individualized levels of difficulty during scanning. Findings indicate that discriminability interacts with complexity, to influence decisional difficulty. Modulation as a function of difficulty is maintained with age, as indicated by coupling between increased activation in fronto-parietal regions and suppression in the lateral hubs, however, age has a specific effect in the ventral anterior cingulate cortex (ACC), driven by performance at near-threshold (difficult) levels for the simpler stimulus combination condition, but not the more complex one. Taken together, our findings suggest that the context of difficulty, or what is perceived as important, changes with age, and that decisions that would seem neutral to younger participants, may carry more emphasis with age.

Smoking and the eye: what Québec teenagers know and fear.

BACKGROUND: Although most people associate smoking with lung cancer and heart disease, few are aware of the impact of smoking on ocular health. Studies have suggested a better knowledge of this association might promote higher quit rates, particularly in teenagers. The purpose of our study was to determine the knowledge of teenagers about the effects of smoking on ocular health and the fear associated with several tobacco-related health conditions. METHODS: A self-administered questionnaire was distributed to 180 high school students aged 14 to 17 years. Measured variables included socio-economic demographics, smoking status, knowledge of the effects of smoking on general and ocular health, and level of fear as well as level of motivation to quit smoking associated with the following tobacco-related conditions: lung cancer, cardiovascular disease, heart attack, blindness and deafness. RESULTS: Response rate was 100 per cent. Eleven per cent of responders were smokers. The proportion of smokers who thought smoking could cause blindness was 64.3 per cent while it was 13.5 per cent for non-smokers. The proportion of smokers fearing blindness was 30 per cent, as opposed to 69.8 per cent for non-smokers. The proportion of respondents who thought the presented conditions were 'extremely' or 'very good' reasons to quit were similarly high for all smoking-associated conditions. CONCLUSION: These findings suggest teenagers are unaware of the impact smoking can have on ocular health. Smokers did not seem more concerned about vision loss compared to other tobacco-related diseases, as opposed to non-smokers. Our findings suggest vision loss would be a strong motivator to prevent initiation, but not very effective regarding cessation in this group. However, optometrists should be aware teenagers seem receptive to the message that 'smoking can cause blindness' and use this strategy in order to prevent smoking initiation.

An in-country model of workforce support for trained mid-level eye care workers in Papua New Guinea and Pacific Islands.

To alleviate the significant burden of vision impairment and blindness in low-resource settings, addressing the shortage in human resources in eye care is one of the fundamental strategies. With its postgraduate training programmes, The Fred Hollows Foundation New Zealand (FHFNZ) aims to increase workforce capacity in the Pacific Island countries and territories and Papua New Guinea. This paper presents an in-country model to offer support to graduates, an essential element to retain them in the workforce and ensure they are able to perform the tasks they were trained to do. FHFNZ has designed a workforce support programme employing a standardised process, allowing comparable reporting and providing data for FHFNZ to evaluate its training programmes, outputs as well as professional recognition and integration in the workplace.

Educating smokers about the risk of blindness - insights to improve tobacco product health warning labels.

BACKGROUND: Health warning labels (HWL) on tobacco products help educate smokers about the health effects from smoking; however, there is a need to improve HWL content including images and text to increase effectiveness. In Canada, a HWL was created that communicates smoking's causal association with "blindness" from age-related macular degeneration (AMD). This study surveyed Canadian optometrists about their opinions regarding the image and text used in the "blindness" HWL. METHODS: An online survey was sent to all 4528 registered Canadian optometrists. Respondents were asked if the HWL conveyed important and believable information, and if the picture was appropriate. Optometrists were invited to make open-ended comments about the label which were analyzed using a qualitative analysis framework suitable for health policy evaluation. Frequency distributions were calculated for closed-ended questions. RESULTS: The survey was completed by 850 respondents (19 %). Most respondents (90 %) reported the message was believable/somewhat believable; while 35 % felt the picture was "too graphic". Some respondents reported in their open-ended comments that they were concerned the HWL was internally inconsistent because it reports there is "no effective treatment in most cases" for AMD but the image depicts someone undergoing surgery. There was concern that this may discourage patients from seeking needed treatment. CONCLUSION: The majority of Canadian optometrist respondents were in agreement that the new, "RISK OF BLINDNESS" pictorial HWL includes important, believable information. Some optometrists had concerns that the HWL included a confusing message or a message that may discourage some patients from pursuing treatment for AMD. Future development of blindness-related HWL should seek practitioner input.

Patient tobacco use in optometric practice: a Canada-wide study.

PURPOSE: A national census survey of optometrists in Canada measured knowledge of ocular diseases associated with smoking cigarettes and current practice behaviors related to addressing tobacco use with patients, including prevention and cessation. Optometrists were also asked to identify tools to assist addressing tobacco use with patients. METHODS: An online bilingual (English/French) survey was developed and an e-mail with a link to the survey was sent to all 4528 optometrists registered in Canada. No participation incentives were provided. Frequency data were tabulated for survey items. Logistic regression models were fit to understand respondent characteristics associated with discussing tobacco use prevention and cessation with patients. RESULTS: The response rate was 19% (850 responses). Almost all respondents (98%) believed that smoking cigarettes was a risk factor for developing age-related macular degeneration; approximately half (55%) assessed the smoking status of patients during their initial visit; 7% reported that they discussed the benefits of tobacco use prevention with patients younger than 19 years; and 33% reported that they always or regularly assess their patients' interest in quitting smoking. Respondents who completed the survey in English were more likely (odds ratio, 2.4; 95% confidence interval, 1.01 to 5.65) to deliver prevention messaging, compared with respondents who completed the survey in French. Male respondents were less likely to assess patients' interest in quitting (odds ratio, 0.7; 95% confidence interval, 0.50 to 0.97) than female respondents. Most respondents (90%) were interested in a continuing education program about the impact of smoking on vision and eye health as well as strategies for discussing tobacco cessation and prevention. CONCLUSIONS: Optometrists are aware of the impact of smoking on ocular health; however, most respondents do not systematically engage in tobacco use prevention and cessation practices. Providing optometrists with tools, including continuing education, may help support patient conversations about the risks of tobacco use and improve public health.

Smoking cessation counselling practices among Québec optometrists: evaluating beliefs, practices, barriers and needs.

BACKGROUND: Despite the fact that cigarette smoking is a well known risk factor for many ocular diseases, very little data exist regarding optometrists' interventions in smoking cessation counselling with their patients. The aim of this study was to evaluate the practices, perceptions and educational needs of Québec optometrists regarding smoking cessation counselling. METHODS: A self-administered questionnaire pertaining to smoking cessation counselling practices was mailed to 600 optometrists licensed in Québec. RESULTS: The response rate was 51 per cent. The majority (90 per cent) of respondents (n = 288) reported having the required knowledge of ocular diseases related to smoking. Most respondents recognised that optometrists should ask their patients if they smoke (73 per cent), should advise their smoking patients to stop smoking (65 per cent) and should be cognisant of the resources available that can support patients in their efforts to quit smoking (65 per cent). Few responders asked their patients on a regular basis if they indeed smoked (16 per cent) or advised them to stop, if such was the case (29 per cent). Moreover, only eight per cent of respondents knew the resources toward which they should direct their patients who wish to stop smoking. Only eight per cent of respondents perceived themselves as being competent to offer counselling. For 72 per cent of the respondents, the main obstacle to smoking cessation counselling was the lack of knowledge about counselling. Approximately half (48 per cent) of respondents are interested in acquiring competencies in smoking cessation counselling. CONCLUSION: Based on the results of the present study, optometrists in Québec are well aware of the effects of smoking on ocular health and the importance of educating their patients; however, they might not possess the required skills to assist their patients in quitting smoking. Because they have not received sufficient training, optometrists in Québec remain an untapped resource in tobacco cessation counselling.

Evidence of a possible impact of the menstrual cycle on the reproducibility of scotopic ERGs in women.

The purpose of this study was to investigate the impact of gender and menstrual cycle on the electroretinogram (ERG). Photopic and scotopic ERGs were obtained in 14 females during the luteal and follicular phases of their menstrual cycle and compared to those obtained on two separate (7 days or 14 days apart) sessions from seven age-matched control male subjects. Our results confirm that the amplitude of the photopic ERGs of females is significantly (P < 0.05) larger than males, and this, irrespective of the cycle phase. In comparison, scotopic ERGs revealed significant male-female differences only during the follicular phase. While in males, no significant (P > 0.05) intersession (7 day or 14 day intervals) variability could be demonstrated, significant (P < 0.001) intersession (luteal-follicular) variability was observed in the scotopic ERGs of our female participants, with 8 of the 14 women, demonstrating a marked increase of 20.17 +/- 4.8% in the follicular ERG compared to the luteal. Our data suggests there should be separate normal ERG values for men and women and that the phase of the menstrual cycle should be taken into consideration when interpreting the ERG results from women.