The burden of acute eye conditions on different healthcare providers: a retrospective population-based study.

BACKGROUND: The demand for acute eyecare exponentially outstrips capacity. The public lacks awareness of community eyecare services. AIM: To quantify the burden of acute eyecare on different healthcare service providers in a national population through prescribing and medicines provision by GPs, optometrists, and pharmacists, and provision of care by accident and emergency (A&E) services. A secondary aim was to characterise some of the drivers of this burden. DESIGN AND SETTING: A retrospective data-linkage study set in Wales, UK. METHOD: Analysis of datasets was undertaken from the Secure Anonymised Information Linkage Databank (GP and A&E), the Eye Health Examination Wales service (optometry), and the Common Ailments Scheme (pharmacy) during 2017-2018. RESULTS: A total of 173 999 acute eyecare episodes delivered by GPs (168 877 episodes) and A&E services (5122) were identified during the study. This resulted in 65.4 episodes of care per 1000 people per year. GPs prescribed a total of 87 973 653 prescriptions within the general population. Of these, 820 693 were related to acute eyecare, resulting in a prescribing rate of 0.9%. A total of 5122 eye-related and 905 224 general A&E attendances were identified, respectively, resulting in an A&E attendance rate of 0.6%. Optometrists and pharmacists managed 51.8% (116 868) and 0.6% (2635) of all episodes, respectively. Older females and infants of both sexes were more likely to use GP prescribing services, while adolescent and middle-aged males were more likely to visit A&E. GP prescribing burden was driven partially by economic deprivation, access to services, and health score. Season, day of the week, and time of day were predictors of burden in GP and A&E. CONCLUSION: Acute eyecare continues to place considerable burden on GP and A&E services in Wales, particularly in urban areas with greater economic deprivation and lower overall health. This is likely to increase with a rapidly ageing population. With ongoing pathway development to better utilise optometry and pharmacy, and improved public awareness, there may be scope to change this trajectory.

Ocular therapeutics and the profession of optometry in South Africa.

BACKGROUND:  The role of an optometrist as defined by the World Council of Optometry includes the management of ocular diseases. In 2015, the scope of optometry in South Africa was expanded to include ocular therapeutic drugs. To date approximately 27 optometrists have obtained full certification to exercise ocular therapeutic privileges. AIM:  This study aimed to determine the interest, readiness, as well as challenges, of optometrists for the inclusion of ocular therapeutics into daily practice. SETTING:  The study was set in South Africa. METHODS:  A descriptive, cross-sectional study design was employed. Convenience sampling was used to recruit 420 participants from a study population of optometrists registered with the Health Professions Council of South Africa, with data collected using an online questionnaire hosted on social media platforms and distributed by professional organisations. Data were analysed using the Statistical Package for Social Science version 27. RESULTS:  The majority of respondents (73.3%) reported keenness for ocular therapeutics certification. While 75.7% of respondents had obtained diagnostics certification, only 9.5% were registered with the Health Professions Council of South Africa (HPCSA) with ocular therapeutics certification. Most (92.1%) respondents reported the required minimum of 600 h of clinical training as a major challenge to obtaining ocular therapeutics certification. Almost all (96.9%) of the respondents agreed that ocular therapeutics certification will improve provision of optimal eyecare. CONCLUSION:  South African optometrists support and are personally interested in ocular therapeutics certification. However, while there is a preponderance of diagnostically qualified optometrists, very few are certified for ocular therapeutics with completion of the required clinical training for certification perceived as the greatest challenge.Contribution: This findings in this study highlight that, current requirements to support ocular therapeutics certification of South African optometrists should be reviewed to ensure an enabling environment for the completion of the clinical training.

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

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

Gender distribution in publishing in five leading optometry journals.

PURPOSE: To explore gender distribution in authorship and citation parameters of articles published in five optometry journals included in the Ophthalmology category of Journal Citation Reports. METHODS: The Scopus database was used to retrieve all citable articles published in 2011 and 2021 in Optometry and Vision Science, Ophthalmic and Physiological Optics, Clinical Experimental Optometry, Contact Lens and Anterior Eye, and Eye and Contact Lens. Gender of the first, last and single authors of all articles, and citation parameters of articles published in 2011 up to May 2023 were determined. Gender of the editor-in-chief and members of the editorial board of these journals was investigated (May 2023). RESULTS: Only one journal had a female editor-in-chief and three journals had more males than females in their editorial board. In 2011 and 2021, respectively, 40.1% and 48.0% of articles had female as the first authors ( χ 1 , 948 2 = 5.77; p = 0.02), and 32.7% and 39.6% had female as the last authors ( χ 1 , 948 2 = 4.61; p = 0.03). Gender parity was observed in one journal for the first author and none for the last author in 2011, and in three journals for the first author and one for the last author in 2021. Regarding combinations of male (M) and female (F) first and last authorship positions, the authors of articles in 2011 were MM (44.5%), FM (22.8%), FF (17.3%) and MF (15.4%), and MM (34.6%), FM (25.8%), FF (22.1%) and MF (17.5%) in 2021. Differences between 2011 and 2021 were statistically significant ( χ 3 , 948 2 = 9.80; p = 0.02). The proportion of authorship combinations did not show statistically significant differences among journals in 2011 or in 2021. Neither citation nor self-citation were influenced by gender. CONCLUSIONS: Gender disparities persist in optometry journals, with females being under-represented in senior and leadership positions. Increasing the awareness of gender disparity in authorship is a necessary step towards ensuring fairness in science in general, and optometry in particular.

Access to primary eye care for people living with dementia: a call to action for primary care practitioners to 'think vision'.

Access to allied health services offers significant benefits for people living with dementia, yet access is currently fragmented and inconsistent. The 2023-2024 budget allocated AU$445million to further enable general practice-led, multidisciplinary teams, with integrated care located within practices, including employment of allied health professionals. Such team care models are recognised by The Royal Australian College of General Practitioners as vital to delivery of high-quality care for older adults. They are especially relevant for over 250,000 Australians who live with dementia in the community. However, not all allied health professionals are currently based within general practices. Future, sustainable general practice-led models of multidisciplinary care that connect patients with external allied health providers could be considered for a comprehensive and collaborative approach to care. Our focus is on people living with dementia, who are at greater risk of preventable vision impairment. Poor vision and/or ocular health can be detected and managed through regular eye examinations, which are predominantly delivered by community-based optometrists in Australia, in a primary care capacity. However, people living with dementia are also less likely to have regular eye examinations. In this paper, we highlight the value of ensuring access to primary eye care services as part of post-diagnosis dementia care. We illustrate the important role of primary care practitioners in building and sustaining connections with allied health professions, like optometry, through effective referral and interprofessional communication systems. This can help break down access barriers to dementia-friendly eye care, through promoting the importance of regular eye tests for people living with dementia.

Optometrists need to incorporate their understanding of the impact of dry eye disease in their patient management.

SIGNIFICANCE: The impact of dry eye disease on patients' daily lives is understood by optometrists, but they seldom use this understanding in their patient management. PURPOSE: Dry eye disease can significantly impact a person's daily life and is known to cause psychological symptoms. Treating and managing patients with dry eye disease can be challenging, as an approach based solely on signs is unlikely to reflect patients' true burden. Because optometrists play a crucial role in the care of dry eye disease patients, it is necessary to examine their awareness of the negative impact of dry eye disease on patients' daily lives and how they manage this during their consultation time, including diagnosis and management. METHODS: This study has an exploratory, qualitative research design. Twelve semistructured online interviews were conducted with optometrists in second-line eye care through a convenience sample. The interviews were recorded, transcribed verbatim, and analyzed after a thematic analysis. RESULTS: The main findings were that few optometrists actively asked about patients' perceived burden, many optometrists did not mention all the possible treatment options or practical advice that could benefit dry eye disease patients, and few were aware of the possible help that other health care providers could provide, besides the optometrist. CONCLUSIONS: Dutch optometrists are aware of the impact that dry eye disease can have on their patients' daily lives, but seldom use this information as part of their management plan.

Profile of contact lens prescribing in GCC countries.

PURPOSE: This study aimed to report the pattern of contact lens prescribing from the Gulf Cooperation Council (GCC) countries. METHODS: Optometrists in the GCC region were contacted to participate in a web-based survey hosted on Qualtrics XM (Provo, Utah, USA). The survey methodology was adapted from the International Contact Lens Prescribing Consortium, and participants were asked to report their last five lens fits. It collected information on practitioner demographics (age, gender, nationality, qualification, country of practice, and number of years of experience), CL user demographics (age and gender) and on lens specific details such as lens type, lens design, lens material, replacement plan, and modality of lens wear. Descriptive statistics were used to analyse and report the data. RESULTS: This study reports 739 contact lens fits by 174 practitioners from six GCC countries. The average age of the patients was 29.72 ± 9.07 (Mean ± SD) years and 64 % of them were females. The majority (80.2 %) were fitted with soft contact lenses, with 59 % preferring silicone hydrogels, 20 % wearing them for cosmetic purposes and nearly half of them disposed of their lenses daily (55 %). Among the RGP lenses, 41 % were scleral lenses. This survey demonstrated a greater proportion of new lens fits (55 % vs. 37 %), disposable hydrogel lens use (21 % vs. 13 %), and a preference for cosmetic contact lenses (20 % vs. 4 %) compared to the international data. CONCLUSION: The pattern of CL prescriptions in the GCC region closely resembled the global trend. The survey observed a higher preference towards frequent replacement soft lenses, a greater proportion of silicone hydrogel lenses, a higher percentage of rigid lens fits, a greater affinity for cosmetic contact lenses, and a higher percentage of new fits. These trends suggest that contact lens prescription habits in the region are likely to continue evolving in the future.

Talkin' 'bout my(opia) generation: The impact of Optometry and Vision Science.

VIRTUAL ISSUE EDITORIAL: This editorial fronts the first virtual issue for Optometry & Vision Science. Virtual issues are a collection of papers from previously published issues of the journal that are brought together in a single, online publication. They highlight the important contribution the journal has made in supporting myopia research. All the papers referenced and previously published in Optometry & Vision Science will be made free access for 1-month. The collection can be accessed here: https://journals.lww.com/optvissci/pages/collectiondetails.aspx?TopicalCollectionId=16.

Glaucoma Agreement in New Zealand (GAINZ).

CLINICAL RELEVANCE: With an ageing population, ophthalmologists are becoming burdened with glaucoma management, and patient care can be delayed. Therefore, the use of optometrists in glaucoma management can help alleviate the burden. BACKGROUND: The ageing population and subsequent rise of glaucoma prevalence are putting a strain on the public health system in New Zealand. Glaucoma collaborative care between optometrists and ophthalmologists has been gaining support with the aim to reduce this burden on ophthalmologists. There has been little investigation of the agreement in care and management of mild-to-moderate severity glaucoma patients by optometrists and ophthalmologists. METHODS: One hundred and three glaucomatous eyes were used in a survey where clinical history and examination, intraocular pressures (IOPs), visual field testing and optical coherence tomography (OCT) imaging were evaluated for glaucoma progression and decision-making regarding subsequent management by four participants. Two participants were glaucoma-credentialled optometrists (Group 1), and the other two were glaucoma specialists (Group 2). RESULTS: With respect to glaucoma progression, Spearman coefficients identified strong agreement between the two groups for IOP, visual fields and overall status and moderate agreement for OCT imaging. A confusion matrix was used to analyse management and found 80% ± 10% agreement between the two groups. Review periods gave an agreement of 55% ± 20% between the two groups. CONCLUSION: There was strong agreement in the assessment of glaucoma progression between the two groups. The 80% level of agreement for subsequent management between the two groups is comparable to other published reports. These results provide some reassurance that a collaborative care system can perform safely and as intended.

Improving optometry student interpersonal skills through online patient, clinician and student evaluation and feedback.

CLINICAL RELEVANCE: Interpersonal skills are crucial for successful clinician-patient interactions. To prepare future optometrists for clinical practice, pedagogical evaluation is important to support the implementation of new strategies for teaching and evaluating interpersonal skills. BACKGROUND: Optometry students largely develop their interpersonal skills through in-person patient interactions. Telehealth is increasing, yet strategies to develop the interpersonal skills of students for teleconsulting have not been explored. This study aimed to assess the feasibility, effectiveness and perceived usefulness of an online, multisource (patients, clinicians and students) evaluation and feedback program for developing interpersonal skills. METHODS: Via an online teleconferencing platform, optometry students (n = 40) interacted with a volunteer patient, observed by a teaching clinician. Patients and clinicians evaluated the interpersonal skills of the student in two ways: (1) qualitative written feedback, and (2) quantitative rating (Doctors' Interpersonal Skills Questionnaire). All students received written patient and clinician feedback after the session, but not their quantitative ratings. A subset of students (n = 19) completed two sessions, self-ratings, and were provided with their written feedback and an audiovisual recording from their first interaction before completing the second session. All participants were invited to complete an anonymous survey at program completion. RESULTS: Patient and clinician overall interpersonal skills ratings were positively correlated (Spearman's r = 0.35, p = 0.03) and showed moderate agreement (Lin's concordance coefficient = 0.34). Student self-ratings did not match patient ratings (r = 0.01, p = 0.98), whereas there was moderate agreement between clinician and student ratings (Lin's concordance coefficient = 0.30). Ratings improved at the second visit (p = 0.01). Patient ratings were higher than clinicians (p = 0.01) and students (p = 0.03). All participants agreed that the program was feasible, useful and effective at fostering good interpersonal skills. CONCLUSION: Multisource feedback about interpersonal skills contributes to improvement in student performance. Patients and clinicians can evaluate and provide useful feedback to optometry students about their interpersonal skills using online methods.

Distance horizontal fusional facility (DFF): A new diagnostic vergence test for the acquired brain injury (ABI) population.

PURPOSE: To report the retrospectively-based, clinical diagnostic findings for the horizontal, distance, fusional facility (DFF) test in the non-TBI (traumatic brain inury), ABI (acquired brain injury) population. METHODS: The DFF test (4 pd base-out/2 pd base-in) was assessed and compared retrospectively in the first author's optometric practice in three clinical populations: (1) post-mTBI, visually-symptomatic (n = 52), (2) post-ABI, non-mTBI, visually-symptomatic (n = 34), and (3) visually-normal, visually asymptomatic (n = 44). RESULTS: The DFF values in each group were significantly different from each other (p < 0.05). The mean non-TBI, ABI group value was significantly lower than found in the mTBI group, and both were significantly lower than the mean found in the normal cohort (p < 0.05). There was a significant reduction in DFF with increased age (p < 0.001). ROC values for the AUC ranged from excellent to acceptable (0.94-0.74). CONCLUSION: The DFF test is a new and useful way to assess horizontal, distance, dynamic, fusional facility in those with presumed non-mTBI, ABI neurological conditions to assist in its diagnosis.

Keratoconus Management in the Community: A Survey of Optometrists.

OBJECTIVES: Defining the patterns of practice and referral criteria of optometrists within New Zealand to investigate the diagnosis and management of keratoconus. METHODS: Optometrists recruited through the New Zealand Association of Optometrists, Cornea and Contact Lens Society of New Zealand, and private practices were invited to complete an anonymous survey. RESULTS: Responses were received from 168 optometrists (representing 20.0% of the optometrist population). Half (48%) of optometrists had ≥15 years of experience, and 22% prescribed soft contact lenses daily, whereas only 6.4% prescribed rigid gas-permeable (RGP) lenses daily. The main barriers to prescribing RGPs were experience with fitting, low market demand, and patient discomfort. When referring to an ophthalmologist, 41% reported referring on progression of corneal parameters, 27% on initial diagnosis, 21% at no set time, and 10% with a reduction in visual acuity. Most optometrists (64%) would refer for possible surgery when visual acuity dropped between 6/9 and 6/12. Optometrists with greater experience were more likely to prescribe RGP lenses and co-manage patients with ophthalmologists. Ownership of a corneal imaging unit suggested an increased likelihood of prescribing RGP lenses but did not alter referral patterns. CONCLUSION: This survey provides an overview of current practice and highlights the importance of optometrists in the diagnosis and management of keratoconus. There was a significant discrepancy in keratoconus management, regarding optical correction modality and referral criteria for ophthalmology review. Further interdisciplinary work is required between optometry and ophthalmology to standardize referral guidelines and enhance visual outcomes.

Ametropia detection using a novel, compact wavefront autorefractor.

INTRODUCTION: Despite the well-known reproducibility issues of subjective refraction, most studies evaluating autorefractors compared differences between the device and subjective refraction. This work evaluated the performance of a novel handheld Hartmann-Shack-based autorefractor using an alternative protocol, which considered the inherent variability of subjective refraction. METHODS: Participants underwent an initial measurement with a desktop autorefractor, two subjective refractions (SR1 and SR2) and a final measurement with the QuickSee Free (QSFree) portable autorefractor. Autorefractor performance was evaluated by comparing the differences between the QSFree and each of the subjective refractions with the difference between the subjective refractions (SR1 vs. SR2) using Bland-Altman analysis and percentage of agreement. RESULTS: A total of 75 subjects (53 ± 14 years) were enrolled in the study. The average difference in the absolute spherical equivalent (M) between the QSFree and the SR1 and SR2 was ±0.24 and ±0.02 D, respectively, that is, very similar or smaller than the SR1 versus SR2 difference (±0.26 D). Average differences in astigmatic components were found to be negligible. The results demonstrate that differences between QSFree and both subjective refractions in J0 and J45 were within ±0.50 D for at least 96% of the measurements. The limits of agreement (LOAs) of the differences between QSFree and SR1, as well as QSFree and SR2, were higher than those observed between SR1 and SR2 for M, J0 and J45 . CONCLUSIONS: A protocol was designed and validated for the evaluation of a refractive device to account for the variability of subjective refraction. This protocol was used to evaluate a novel portable autorefractor and observed a smaller difference between the device and subjective refractions than the difference between the two subjective refraction measurements in terms of mean bias error, although the standard deviation was higher.

Building and maintaining interprofessional collaborative practice in eyecare: Learnings from the Queensland Paediatric Optometry Alignment Program.

PURPOSE: The Queensland Children's Hospital Paediatric Optometry Alignment Program commenced with a pilot phase to assess its feasibility, effectiveness and acceptability. This study identified the barriers that hinder effective interprofessional collaboration and the facilitators that contribute to its success, and assessed changes in optometrists' satisfaction since the pilot phase of the collaborative care programme. METHODS: Qualitative deductive and inductive content analysis was applied to open-ended free-text survey responses collected in 2018 from the optometrists involved in the Program's pilot phase. The responses were coded using the Theoretical Domains Framework (TDF) to categorise barriers and facilitators into key themes. Key behavioural determinants were mapped to the COM-B (Capability, Opportunity, Motivation-Behaviour) elements of the Behaviour Change Wheel model to identify intervention strategies. Intervention recommendations were derived from behaviour change mapping and compared with programme quality improvement initiatives. A cross-sectional explanatory survey informed by the TDF was conducted within the current 2023 cohort, and a longitudinal comparative analysis was carried out using data from the 2018 survey. RESULTS: Among the 97 surveys distributed in 2018, 44 respondents participated; from this group, 38 individuals contributed a total of 200 free-text responses. Facilitators (240 comments) outnumbered barriers (65 comments). Key facilitators were accessible and timely care, professional development, confidence and positive outcome beliefs. Barriers included communication, information handover, credibility, relationships and skill gaps. Optometrists actively engaged in the programme in 2023 reported heightened satisfaction with their involvement, increased confidence and greater engagement in paediatric eyecare delivery. However, challenges in clinical information transfer persist. CONCLUSION: The interprofessional collaborative model of paediatric eyecare has contributed efficiencies within the health system by building paediatric care capacity in the community, fostering professional credibility and promoting interdisciplinary trust. Insights gained should prove valuable for other paediatric eyecare services exploring hospital-to-community care models.

Genetic testing and gene therapy in retinal diseases: Knowledge and perceptions of optometrists in Australia and New Zealand.

With advances in gene-based therapies for heritable retinal diseases, primary eye care clinicians should be informed on ocular genetics topics. This cross-sectional survey evaluated knowledge, attitudes, and concerns regarding genetic testing and gene therapy for retinal diseases among optometrists in Australia and New Zealand. Survey data included practitioner background, attitudes and practices towards genetic testing for monogenic inherited retinal disease (IRDs) and age-related macular degeneration, and knowledge of ocular genetics and gene therapy. Responses were received from 516 optometrists between 1 April and 31 December 2022. Key perceived barriers to accessing genetic testing were lack of clarity on referral pathways (81%), cost (65%), and lack of treatment options if a genetic cause is identified (50%). Almost all respondents (98%) believed that ophthalmologists should initiate genetic testing for IRDs and fewer understood the role of genetic counsellors and clinical geneticists. This study found that optometrists in Australia and New Zealand have a high level of interest in ocular genetics topics. However, knowledge gaps include referral pathways and awareness of genetic testing and gene therapy outcomes. Addressing perceived barriers to access and promoting sharing of knowledge between interdisciplinary networks can set the foundation for genetic education agendas in primary eye care.

Sistema de competencias laborales para tecnólogos de la salud licenciados en Optometría y Óptica / Job competency system for health technologists licensed in Optometry and Optics

Fundamento: la calidad de un servicio de salud parte del nivel de la competencia y desempeño de sus trabajadores en el cumplimiento de sus funciones laborales y sociales. Objetivo: elaborar un sistema de competencias laborales para tecnólogos de la salud licenciados en Optometría y Óptica. Métodos: se realizó una investigación de desarrollo tecnológico en el campo de la educación médica, durante enero 2021- enero 2022 en instituciones del nivel secundario del municipio Holguín. Se utilizaron métodos teóricos, empíricos y estadísticos que permitieron la triangulación metodológica de los resultados. Se tuvo en cuenta el criterio de especialistas para la valoración del sistema de competencias elaborado. Resultados: se identificaron insuficiencias para ejecutar procederes óptico-optométricos, limitada participación en actividades científico investigativas, baja categorización docente e investigativa, debilidades en la función profesor-tutor y escasa actividad de superación permanente. Se elaboró un sistema de competencias laborales para tecnólogos de la salud licenciados en Optometría y Óptica diseñadas en correspondencia con el ejercicio de sus funciones. Conclusiones: el diagnóstico realizado demostró la necesidad de un sistema de competencias laborales para contribuir al perfeccionamiento del desempeño laboral de estos profesionales, el cual fue valorado como factible, pertinente y útil de ser aplicado.

Background: the quality of a health service is based on the level of competence and performance of its workers in fulfilling their job and social functions. Objective: to develop a system of job skills for health technologists Bachelors in Optometry and Optics. Methods: a technological development investigation was carried out in the field of medical education, from January 2021 to January 2022 in secondary level institutions of the Holguín municipality. Theoretical, empirical and statistical methods were used that allowed the methodological contrast of the results. The criteria of specialists was taken into account for the assessment of the developed competency system. Results: insufficiencies were identified to carry out optical-optometric procedures, limited participation in scientific research activities, low teaching and research ranking, weaknesses in the teacher-tutor function and little permanent improvement activity. A system of job competencies was developed for health technologists with degrees in Optometry and Optics designed in accordance with the exercise of their duties. Conclusions: the diagnosis carried out demonstrated the need for a system of work competencies to contribute to the improvement of the work performance of these professionals, which was valued as feasible, relevant and useful to be applied.