Real-world application of a smartphone-based visual acuity test (WHOeyes) with automatic distance calibration.

BACKGROUND: To develop and assess the usability of a smartphone-based visual acuity (VA) test with an automatic distance calibration (ADC) function, the iOS version of WHOeyes. METHODS: The WHOeyes was an upgraded version with a distinct feature of ADC of an existing validated VA testing app called V@home. Three groups of Chinese participants with different ages (≤20, 20-40, >40 years) were recruited for distance and near VA testing using both an Early Treatment Diabetic Retinopathy Study (ETDRS) chart and the WHOeyes. The ADC function would determine the testing distance. Infrared rangefinder was used to determine the testing distance for the ETDRS, and actual testing distance for the WHOeyes. A questionnaire-based interview was administered to assess the satisfaction. RESULTS: The actual testing distance determined by the WHOeyes ADC showed an overall good agreement with the desired testing distance in all three age groups (p>0.50). Regarding the distance and near VA testing, the accuracy of WHOeyes was equivalent to ETDRS. The mean difference between the WHOeyes and ETDRS ranged from -0.084 to 0.012 logMAR, and the quadratic weighted kappa (QWK) values were >0.75 across all groups. The test-retest reliability of WHOeyes was high for both near and distance VA, with a mean difference ranging from -0.040 to 0.004 logMAR and QWK all >0.85. The questionnaire revealed an excellent user experience and acceptance of WHOeyes. CONCLUSIONS: WHOeyes could provide accurate measurement of the testing distance as well as the distance and near VA when compared to the gold standard ETDRS chart.

Prevalence of refractive error within a Portuguese sample of optometric records.

PURPOSE: Considering the burden of refractive error, clinical-based research methods are often used as epidemiological tools. This study aimed to generate evidence on the prevalence and distribution of refractive error in Portugal. METHODS: A cross-sectional retrospective study was designed to review optometric records from Portuguese practices during July 2021. RESULTS: 348 optometric records were analysed. Subjects had a mean age of 44.2 ± 19.2 years (range 6-81) and 58.4% were female. The mean spherical equivalent was myopic, -0.65 ± 2.38 Diopters (D), varying from a minimum of -13.63 to a maximum of 6.25 D. According to sex, the mean spherical equivalent was -0.76 ± 2.29 D for female and -0.49 ± 2.49 D for male, with no significant difference between them (p = .307). The distribution of the spherical equivalent mean across the age groups, linearly varies from a myopic -1.62 ± 1.74 D in the age group of [6 - 29]; -1.58 ± 2.80 D in [30 - 44]; -0.09 ± 2.40 in [45 - 59] to a hyperopic 0.67 ± 1.61 D in the group of [60 - 81]. High myopia had a prevalence of 2.7% in the sample. Myopia was the most prevalent refractive error in the sample representing 41.3%. In the age group [6-29], myopia had a prevalence of 69.3%. Hyperopia had a prevalence in the sample of 29.7%. CONCLUSIONS: Myopia represents the most prevalent refractive error within the sample and is the prevalence is higher in the younger age groups, demonstrating a shift towards an increase of myopia in the next years.

Competencies and training needs of the Portuguese optometrists - a national inquiry.

PURPOSE: The World Health Organization places the Optometrist as the primary eye care provider, clearly defining its competencies and scope of practice. In Portugal, there are no studies about Optometrists professional competencies and the profession remains unregulated. The aim of this study was to describe the Portuguese optometrists' professional competencies model and to identify possible training needs felt. METHODS: A questionnaire survey was carried out, with the Portuguese optometric population as target group, ascertaining the level of academic qualifications, the clinical procedures most frequently performed, the training needs felt and the confidence levels in the performance of certain procedures. RESULTS: The 444 validated surveys represent 28.41% of the study population, making it a representative sample. The validated sample had 78.8% of Graduates, 20.5% of Masters and 0.7% of PhDs in Optometry. CONCLUSIONS: The results of this study allowed us to conclude that the competences most frequently performed by Portuguese optometrists are a very reductive view of the internationally stipulated, based on Refraction, Basic Ocular Health Assessment, Contactology and Paediatric Optometry in School Age (>6 years old). The most important training needs occur at the level of Applied Ocular Pharmacology, Prismatic Prescription, Optometry in Special Needs Populations, Contactology in Special Cases, Low Vision and Clinical/Hospital Internship. Professional experience of 10 years or more and Master's/PhD qualifications give rise to more skills, higher levels of confidence and lower training needs. Higher frequency of execution of certain procedures translates into high levels of confidence and less training needs in the area.

Post-COVID-19 and the Portuguese national eye care system challenge.

The pandemic of the severe acute respiratory syndrome disease caused by the new coronavirus SARS-CoV-2 (COVID-19), had profound impact in many countries and their health care systems. Regarding Portugal, a suppression strategy with social distancing was adopted, attempting to break the transmission chains, bending the epidemy curve and reducing mortality. These measures seek to prevent an eventual National Health Service over-running, enforcing the suspension of all elective and non-urgent health care. Despite the success in so far, there is a consensus on the need to recover the previous level of health care provision and further enhance it. The Portuguese National Health Service, as a public, universal access, health care system funded by the State proved, in this context, its importance and relevance to the Portuguese population. However, long standing issues, such as the pre pandemic over long waiting lists for hospital ophthalmology attendance, whose determinants are fully identified but still unmet, emerge amplified from this pandemic. The lack of primary eye care in the National Health Service is a significant bottleneck, placing a huge stress on hospital-based care. An exclusive ophthalmologist's center care was over-runned before pandemic and will be even more so. The optometrist's exclusion from differentiated, multisectoral and multidisciplinary eye care teams remains the main hurdle to overcome and insure universal eye care in Portugal. National Health Service highlights the consequences of an overcome model. Universal eye care more than ever demands an evidence-based, integrated approach with primary eye care, in the community, on time and of proximity.

La pandemia del síndrome respiratorio agudo grave causado por el nuevo coronavirus SARS-CoV-2 (COVID-19) ha tenido amplias repercusiones en muchos países y en sus sistemas sanitarios. En Portugal, se ha adoptado una estrategia de contención basada en el distanciamiento social, con la cual se ha intentado cortar las cadenas de transmisión, frenar la curva de la epidemia y reducir la mortalidad. Con estas medidas se trataba de evitar un eventual desbordamiento del Servicio Nacional de Salud y se imponía la suspensión de toda la atención médica programada, que no fuera urgente. A pesar del éxito logrado hasta este momento, existe consenso sobre la necesidad de recuperar el nivel anterior de atención médica y fomentar su mejora. El Servicio Nacional de Salud de Portugal, como sistema sanitario público y de acceso universal, a cargo del Estado, ha demostrado, en este contexto, su importancia y pertinencia para la población portuguesa. Sin embargo, los problemas que acarrea desde hace mucho tiempo, como las largas listas de espera, anteriores a la pandemia, en la asistencia oftalmológica hospitalaria, cuyos factores determinantes están completamente identificados, pero que continúan sin solución, se han visto agravados a resultas de esta pandemia. La falta de atención primaria oftalmológica en el Servicio Nacional de Salud es un importante cuello de botella, que ejerce una enorme presión en la atención hospitalaria. La atención de un centro exclusivamente oftalmológico estaba desbordada antes de la pandemia y lo estará aún más después de esta. La exclusión de los optómetras de los equipos de atención oftalmológica diferenciados, multisectoriales y multidisciplinarios continúa siendo el principal obstáculo que debe superar y asegurar la atención oftalmológica universal en Portugal. El Servicio Nacional de Salud hace hincapié en las consecuencias de un modelo superado. La atención oftalmológica universal exige, más que nunca, un enfoque integral basado en la evidencia para abordar la atención primaria oftalmológica en la comunidad, puntual y de proximidad.