Evaluating patient flow through an emergency ophthalmology consult service in a tertiary care academic centre in Quebec.

OBJECTIVE: This study aims to characterize the epidemiology, common reasons, and diagnostic accuracy of referrals made by emergency departments (EDs) and optometrists to an emergency ophthalmology consultation service as well as to identify opportunities for improvement. DESIGN: Retrospective chart review. PARTICIPANTS: A total of 1249 referrals made to the emergency ophthalmology consultation service at a tertiary care centre between July 2018 and June 2019. METHODS: Patient charts were examined, and clinical variables were extracted. Statistical significance (p < 0.05) was determined via t tests and χ2 tests for continuous and categorical variables, respectively. Diagnostic accuracy of providers and time delay between referral and ophthalmologic encounter also were assessed. RESULTS: Both EDs and optometrists most often referred cases with vitreoretinal (36.48% and 37.19%, respectively) and corneal pathology (21.42% and 20.25%, respectively). Optometrists (n = 240; 52.48%) were significantly more accurate in their diagnoses than EDs (n = 940; 32.45%; p < 0.00001). Specifically, optometrists were significantly more accurate when diagnosing anterior-chamber (n = 29; 58.62%; p = 0.039) and vitreoretinal (n = 89; 60.67%; p < 0.00001) pathology than EDs (anterior chamber, n = 77, 36.36%; vitreoretinal, n = 344, 18.90%). Across all ED referrals (n = 940), 58 (6.17%) had a prolonged delay. Across all optometrist-to-ED referrals (n = 150), 6 (4.00%) had a prolonged delay. Accounting for all cases, the total incidence of prolonged delay was 5.87%. CONCLUSIONS: Our results demonstrate the need for improved communication between optometrists and ophthalmologists to reduce the wait-time burden on EDs. Patients may benefit from direct referral by optometrists to ophthalmologists. Education of allied health professionals on ophthalmic disease also may improve diagnostic accuracy.

Vertex distance variability of the Vision-S™ 700 refractors in normal population / Variabilidade da distância vértice do refrator Vision-S™ 700 em uma população normal

ABSTRACT Objective: To study vertex-optical distance variation and estimate its impact on manifest refraction. Methods: Prospective study in a private clinic using the Vision-S™ 700 with five forehead positions. Forehead on the third position showed the closest vertex-optical distance of 12mm. Results: Analysis of 52 eyes from 26 patients revealed mean differences in vertex-optical distance of 12.25mm (right eye) and 11.75mm (left eye). A 2mm change in vertex-optical distance resulted in a 0.05D change for a 5D spherical equivalent and 0.20D for a 10D equivalent. Conclusion: Vertex-optical distance varies among patients and is influenced by forehead adjustment. These variations impact refraction accuracy and treatment evaluation. Adjusting the forehead to the third position on the Vision-S™ 700 is recommended.

RESUMO Objetivo: Estudar a variação da distância vértice-óptico, de acordo com o ajuste da testa, e estimar seu impacto na refração manifesta. Métodos: Estudo prospectivo realizado em clínica privada. A refração foi realizada utilizando cinco posições preestabelecidas com o Vision-Sa 700. A testa disposta na terceira posição apresentou distância vértice do refrator mais próxima de 12mm. Resultados: Foram analisados 52 olhos de 26 pacientes. A diferença média da distância vértice do refrator no olho direito foi de 12,25mm (variação de 11,50mm) e, no olho esquerdo, 11,75mm (variação de 12,00mm). O impacto foi de 2mm na distância vértice do refrator, fomentando em uma mudança de 0,05D para um equivalente esférico de 5D e 0,20D para um equivalente de 10D. Conclusão: A distância vértice do refrator varia entre pacientes, estando relacionada ao ajuste da testa. As variações afetam a precisão da refração, impactando no ajuste dos óculos, das lentes de contato e na avaliação pós-operatória de cirurgia refrativa. Sugerimos ajustar a posição da testa para terceira posição no Vision-S™ 700, se a distância vértice do refrator não for medida em todos os pacientes.

Point-of-care tools to support optometric care provision to people with age-related macular degeneration: A randomised, placebo-controlled trial.

PURPOSE: Age-related macular degeneration (AMD) is a leading cause of vision impairment. This randomised placebo-controlled trial investigated whether point-of-care tools can improve optometrists' AMD knowledge and/or care provision. METHODS: Australian optometrists (n = 31) completed a demographics survey and theoretical AMD case study multiple-choice questions (MCQs) to assess their confidence in AMD care provision and AMD knowledge. Participants were then randomly assigned to one of three point-of-care tools (online 'Classification of Age-related macular degeneration and Risk Assessment Tool' (CARAT), paper CARAT, or 'placebo') to use when providing care to their subsequent 5-10 AMD patients. Participants self-audited the compliance of their AMD care to best practice for these patients, and a similar number of consecutive patients seen prior to enrolment. Post-intervention, participants retook the AMD knowledge MCQs and confidence survey. RESULTS: A total of 29 participants completed the study. At the study endpoint, clinical confidence relative to baseline improved with the paper CARAT, relative to placebo, for knowledge of AMD risk factors, asking patients about these factors and referring for medical retinal sub-specialist care. There were no between-group differences for the change in AMD knowledge scores. Considering record documentation for patients with any AMD severity, there were no significant between-group differences for documenting patient risk factors, AMD severity, clinical examination techniques or management. In a sub-analysis, the change from baseline in compliance for documenting discussions about patient smoking behaviours for early AMD patients was higher with use of the online CARAT relative to placebo (p = 0.04). For patients with intermediate AMD, the change from baseline in documenting the risk of progression to late AMD was greater among practitioners who used the paper CARAT, relative to placebo (p = 0.04). CONCLUSIONS: This study demonstrates that point-of-care clinical tools can improve practitioner confidence and aspects of the documentation of AMD clinical care by optometrists as assessed by self-audit.

Reducing the Global Burden of Myopia by Delaying the Onset of Myopia and Reducing Myopic Progression in Children: The Academy's Task Force on Myopia.

In 2019, the American Academy of Ophthalmology (AAO) created the Task Force on Myopia in recognition of the substantial global increases in myopia prevalence and its associated complications. The Task Force, led by Richard L. Abbott, MD, and Donald Tan, MD, comprised recognized experts in myopia prevention and treatment, public health experts from around the world, and organization representatives from the American Academy of Family Physicians, American Academy of Optometry, and American Academy of Pediatrics. The Academy's Board of Trustees believes that myopia is a high-priority cause of visual impairment, warranting a timely evaluation and synthesis of the scientific literature and formulation of an action plan to address the issue from different perspectives. This includes education of physicians and other health care providers, patients and their families, schools, and local and national public health agencies; defining health policies to ameliorate patients' access to appropriate therapy and to promote effective public health interventions; and fostering promising avenues of research.

Routine slit lamp examination procedures: A risk for severe acute respiratory syndrome coronavirus 2 infection to eye care professionals.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a highly infectious coronavirus, has been rapidly spreading after its surge in China in December 2019. It is currently a global pandemic. A myriad of transmission routes have been documented, however established thus far, are respiratory droplet, contact and airborne transmissions. Susceptible persons at proximity, usually within 1-2 m, to infected persons are largely at risk of being infected. Unfortunately, health workers usually evaluate patients within this distance. Eye care professionals (ECPs) are faced with a higher risk scenario of being infected as they undertake routine clinical eye examination procedures at a close face-to-face proximity to patients, which place them at a high risk of respiratory droplets and aerosolised particles, particularly from asymptomatic and pre-symptomatic carriers. The slit lamp examination procedure is typically at a distance of between 0.25 m and 0.5 m. While undertaking certain procedures on the slit lamp, such as gonioscopy and slit lamp indirect ophthalmoscopy, the ECP holds the accessory lenses either directly on the patient's eye or at about 5-10 cm from the patient's face, respectively. The authors found it pertinent to articulate this narrative review article to guide slit lamp examination practice by ECPs during routine ophthalmic evaluation, with a view to reducing the spread of SARS-CoV-2 to ECPs. In conclusion, ECPs are at increased risk of infection due to high-risk scenarios for routine slit lamp examination procedures of the eye. Adherence to standard precautionary measures with slit lamp use is highly recommended.

Delisted routine eye examinations for nonrefractive eye conditions: a comparative analysis.

BACKGROUND: In 2004, Ontario delisted routine eye examinations for people aged 20-64 years, potentially encouraging patients seeking eye care to visit government-insured primary care providers (PCPs) rather than optometrists whose services had been deinsured. We investigated if utilization of PCP services for nonrefractive eye conditions increased after 2004 among Ontarians who were affected by the delisting. METHODS: We conducted a comparative analysis of the utilization of PCP services for nonrefractive eye conditions in Ontario using administrative data from 2000 to 2014. We included participants without a visit to government-insured optometrists or ophthalmologists in the year before the study year; we excluded participants with existing diabetes. Changes in utilization before and after delisting were statistically assessed using segmented regression analysis in subgroups stratified by age, sex, rurality and neighbourhood income. RESULTS: A significant increase in utilization of PCP services for nonrefractive ocular diagnoses after 2004 was documented among people affected by the delisting: 17.8% (95% confidence interval [CI] 17.0% to 18.7%) for people aged 20-39 years and 11.6% (95% CI 10.6% to 12.5%) for people aged 40-64 years. This corresponds to an increase in the number of patients who visited PCPs for nonrefractive ocular diagnoses of 10 690 (95% CI 321 to 21 059) for people aged 20-39 years and 20 682 (95% CI -94 to 41 457) for people aged 40-64 years. Among people aged 65 years and older (an age group not affected by the delisting), utilization of PCP services for nonrefractive ocular diagnoses was stable (p = 0.95) throughout the study period. Changes in utilization of PCP services for nonocular diagnoses were nonsignificant among people aged 0-19, 40-64 and 65 years and older. INTERPRETATION: After delisting, utilization of the services of government-funded PCPs for nonrefractive ocular diagnoses significantly increased among Ontarians affected by the delisting. The impact on ocular outcomes and the cost-effectiveness of increased use of PCPs for ocular management warrants further investigation and policy-makers' consideration.

Determinantes sociales de la salud y la enfermedad visual en caficultores de Caldas, Colombia / Social Determinants of Health and Visual Disease in Coffee Harvesters from Colombia

Introducción: Aunque existen iniciativas globales que buscan mejorar la salud visual en las poblaciones y alcanzar una mayor inclusión social de las personas afectadas con pérdida de la visión, coexisten barreras importantes como la poca accesibilidad y equidad de los servicios de salud y las diferencias económicas y de género que impiden obtener mejores indicadores. Objetivo: Establecer la asociación entre los determinantes sociales de la salud y la enfermedad visual en una comunidad de caficultores en el Departamento de Caldas, Colombia. Métodos: Estudio descriptivo correlacional en el que participaron 1387 caficultores. La información se recolectó en el momento de la valoración por optometría. Se aplicó un cuestionario para explorar los determinantes sociales de la salud estructurales e intermedios y datos relacionados con salud visual. La asociación entre las variables fue establecida a través de la prueba de chi cuadrado. Resultados: La edad promedio fue de 57 años ± 10,7 años, 77,3 por ciento hombres, el 97,2 por ciento pertenecía al estrato socioeconómico bajo y un 73 por ciento habían realizado estudios primarios. Las enfermedades visuales más frecuentes fueron los trastornos de refracción en un 85,7 por ciento, el principal diagnóstico fue la presbicia con una prevalencia de 75,8 por ciento (IC 95 por ciento: 73,5 por ciento; 78,03 por ciento). En el análisis bivariado se encontró asociación estadísticamente significativa (p < 0,05) entre el diagnóstico de optometría y los determinantes sociales de la salud estructurales e intermedios: sexo, estado civil, grupo de edad, nivel educativo, estrato socioeconómico y ocupación. Conclusiones: La enfermedad visual en caficultores se encuentra influenciada por determinantes sociales de la salud estructurales e intermedios, modificables con acciones intersectoriales y transectoriales como el nivel educativo, estrato socioeconómico y la ocupación, los que deben ser incorporados a las políticas públicas para mejorar su calidad de vida y reducir la ceguera prevenible(AU)

Introduction: Although there are global initiatives aimed at improving visual health in populations and at achieving greater social inclusion of people affected with vision loss, important barriers coexist such as poor accessibility and equity of healthcare services and economic and gender-related differences that prevent obtaining better indicators. Objective: To establish the association between the social determinants of health and visual disease in a community of coffee harvesters in the department of Caldas, Colombia. Methods: Descriptive and correlational study with the participation of 1,387 coffee harvesters. The information was collected at the time of optometric assessment. A questionnaire was applied to explore the structural and intermediate social determinants of health and data related to visual health. The association between the variables was established through the chi-square test. Results: The average age was 57 years ± 10.7 years, 77.3 percent were men, 97.2 percent belonged to the low socioeconomic stratum and 73 percent had completed elementary school. The most frequent visual diseases were refractive disorders, account ting for 85.7 percent; and the main diagnosis was presbyopia, with a prevalence of 75.8 percent (95 percent CI: 73.5 percent; 78.03 percent). The bivariate analysis showed a statistically significant association (p<0.05) between the diagnosis of optometry and the structural and intermediate social determinants of health: sex, marital status, age group, educational level, socioeconomic status, and occupation. Conclusions: Visual disease in coffee harvesters is influenced by structural and intermediate social determinants of health, modifiable with intersector and cross-sector actions such as educational level, socioeconomic stratum, and occupation, which must be incorporated into public policies to improve their quality of life and to reduce preventable blindness(AU)

Examination Practices and Referral of Patients With Diabetic Retinopathy by Optometrists in Routine Clinical Care.

BACKGROUND AND OBJECTIVE: To analyze the examination practices and referral of patients with diabetic retinopathy (DR) by optometrists in routine clinical care. PATIENTS AND METHODS: Diabetic patient records from 2012 to 2018 were retrospectively reviewed for documentation of dilated fundus exam (DFE), imaging, follow-up appointments, and referrals. Concordance between clinical exam and coding was also analyzed. RESULTS: For 97.8% of encounters, DFE was performed, the patient was referred for DFE, or DFE was scheduled for follow-up. When DFE was performed at the initial visit, this resulted in referral of 19.8% of patients to an ophthalmologist. Imaging was obtained occasionally, with fundus photos in 2.6% and optical coherence tomography in 14.5% of encounters. Concordance of DR grading between exam and coding was 78.8%. Recommended follow-up times were incorrect based on DR severity level in 13.8% of encounters. CONCLUSION: Although DFE was performed reliably by optometrists, utilization of imaging, DR grading and coding, and appropriate follow-up periods could be improved. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:608-612.].

Preliminary Validation of a Food Frequency Questionnaire to Assess Long-Chain Omega-3 Fatty Acid Intake in Eye Care Practice.

Clinical recommendations relating to dietary omega-3 essential fatty acids (EFAs) should consider an individual's baseline intake. The time, cost, and practicality constraints of current techniques for quantifying omega-3 levels limit the feasibility of applying these methods in some settings, such as eye care practice. This preliminary validation study, involving 40 adults, sought to assess the validity of a novel questionnaire, the Clinical Omega-3 Dietary Survey (CODS), for rapidly assessing long-chain omega-3 intake. Estimated dietary intakes of long-chain omega-3s from CODS correlated with the validated Dietary Questionnaire for Epidemiology Studies (DQES), Version 3.2, (Cancer Council Victoria, Melbourne, Australia) and quantitative assays from dried blood spot (DBS) testing. The 'method of triads' model was used to estimate a validity coefficient (ρ) for the relationship between the CODS and an estimated "true" intake of long-chain omega-3 EFAs. The CODS had high validity for estimating the ρ (95% Confidence Interval [CI]) for total long-chain omega-3 EFAs 0.77 (0.31-0.98), docosahexaenoic acid 0.86 (0.54-0.99) and docosapentaenoic acid 0.72 (0.14-0.97), and it had moderate validity for estimating eicosapentaenoic acid 0.57 (0.21-0.93). The total long-chain omega-3 EFAs estimated using the CODS correlated with the Omega-3 index (r = 0.37, p = 0.018) quantified using the DBS biomarker. The CODS is a novel tool that can be administered rapidly and easily, to estimate long-chain omega-3 sufficiency in clinical settings.

Diagnostic accuracy of non-mydriatic fundus camera for screening of diabetic retinopathy: A hospital based observational study in Pakistan.

OBJECTIVE: To determine the diagnostic accuracy of non-mydriatic fundus camera for the detection of diabetic retinopathy. METHODS: The cross-sectional study was conducted at Al Ibrahim Eye Hospital, Karachi, from January to May 2015, and comprised patients with type 2 diabetes who were screened for diabetic retinopathy. Single 45° fundus image focussed at macula was obtained and labelled using non-mydriatic fundus camera by a trained optometrist. Photos were labelled as positive (diabetic retinopathy present), negative (no diabetic retinopathy) or unreadable. The pupil was then dilated and fundi were examined by ophthalmologist with slit-lamp and fundus lens. Results of fundus examination were labelled as positive, negative or invisible/indecisive. Results of ophthalmologist were taken as the standard reference to evaluate sensitivity and speci?city for detecting diabetic retinopathy with non-mydriatic fundus camera. SPSS 20 was used for data analysis. RESULTS: Total eyes screened numbered 2970 related to 1485 patients. Diabetic retinopathy was found in 646(21.8%) eyes, 485(20.9%) photographs were unreadable and 1839(57.3%) were normal. Ophthalmologist on slit lamp bio-microscopy labelled 736(25%) eyes as positive for diabetes retinopathy, 335(15%) as indecisive and 1899(60%) as normal. The sensitivity of non-mydriatic fundus camera was 400/556 (72%) while specificity was 1548/1794 (86.3%). Positive predictive value and negative predictive value were 400/646 (62%) and 1548/1704 (90%) respectively. The level of agreement was moderate (k=0.0551) for optometrist compared to ophthalmologist. False positive diagnosis by optometrist numbered 78/1839 (4.24%) and false negative was 123/646(19%). CONCLUSIONS: Non-mydriatic fundus camera was found to be a reliable screening tool for detecting and referral diabetic retinopathy cases to ophthalmologist for further evaluation and management.

Optometric Applications for Three-dimensional Printing: A Technical Report from Low Vision Rehabilitation Practice.

SIGNIFICANCE: Delivering personalized three-dimensional (3D)-printed solutions for our patients is easier now than it has ever been. This technological revolution makes things possible that it would be extremely challenging to achieve using traditional approaches. PURPOSE: The purpose of this study was to increase awareness among the optometric and vision science community of opportunities to apply 3D printing to enhance clinical practice and research. METHODS: A widely available fused deposition modeling 3D printing approach was used to fabricate several plastic items for use in optometric practice and low vision rehabilitation. RESULTS: The authors will share nine optometric extensions of 3D printing: (1) an attachment for glare-acuity testing, (2) a disposable cover paddle to limit infection spread for red-eye visits, (3) ophthalmic equipment repair/modification, (4) ophthalmic lens thickness calipers, (5) NoIR lens filter flipper, (6) Optivisor faceplate, (7) EasyPocket lanyard card holder, (8) dome magnifier handle, and (9) a phoropter near card holder. CONCLUSIONS: Designing customized solutions and problem-solving for our patients and offices are becoming easier to do using 3D printing every year. The possible applications for this technology are constantly being expanded. This technology allows for cost-effective production of solutions, some of which would not be feasible otherwise.

Ophthalmology referrals from optometry: a comparative study (the R.O.C.S study).

OBJECTIVE: To characterize emergency optometrist referrals triaged at a tertiary ophthalmology care centre by physical examination findings and provisional diagnosis accuracy. DESIGN: Prospective case review. PARTICIPANTS: Consecutive patients referred to a tertiary eye care clinic for an after-hours ocular consult. METHODS: Variables extracted from the patient charts included date of referral, age, sex, eye(s) under examination, referral visual acuity (VA), referral intraocular pressure (IOP), the referring optometrist's provisional diagnosis, VA at the time of the ophthalmologist consultation, IOP at the time of the ophthalmologist consultation, number of days between referral and ophthalmic consultation, and the ophthalmologist's diagnosis. Optometrist VA measures were correlated against ophthalmologist measures for left eye, right eye, diseased eye, and nondiseased eye. The independent t test was used to compare IOP measures between clinicians, and the absolute frequency of agreement between localization of eye pathology was reported. RESULTS: After categorizing disease by anatomic location, absolute agreement between optometrist provisional diagnosis and ophthalmologist diagnosis was 60.0%. Strong correlations were found between optometrist and ophthalmologist VA measurements. IOP measurements were reported less frequently by optometrists. In cases in which referral IOP was documented, no significant difference was observed between clinician measures. CONCLUSIONS: VA and IOP measurements by optometrists are reliable, although IOP measurements were included less frequently in optometrist referrals. Optometrist referrals correctly localized eye pathology in 60.0% of cases. Two cases of retinal tear and 2 cases of retinal detachment, for which a precise reason for referral is ideal, were referred for other reasons.

Changing trends in postoperative cataract care: impact of electronic patient records in optometrist-delivered shared care.

BACKGROUND: This study evaluates a community optometrist-delivered postoperative care scheme in patients discharged from the hospital ophthalmology department following uncomplicated cataract surgery. AIM: The aim of this study is to assess the efficacy of electronic patient records (EPR) in facilitating co-managed cataract care. METHODS: We performed a retrospective analysis of a prospectively maintained Medisoft EPR database of postoperative cataract review data at a single centre, Sligo University Hospital (SUH), which serves a large and predominantly rural catchment area. All patients undergoing cataract surgery at SUH from October 2012 to September 2013 were included in this study. A total of 39 optometric practices, all with access to the Medisoft EPR software, participated in this pilot co-management scheme. RESULTS: One thousand four hundred and twenty-two cataract surgeries were performed in SUH (55% female, 45% male); 1011 patients (71%) were discharged to the community on the day of cataract surgery. Complete postoperative feedback (i.e. data on refraction, visual acuity and intraocular pressure) was available in 97% of these patients compared to 50% of patients reviewed in the hospital. Patients followed up by optometrists were twice as likely to have complete postoperative clinical details (RR = 1.934, 95% CI: 1.759-2.126, p < 0.0001). Overall, 65% of operations were performed on first eyes. Hospital doctors were more likely to document requirement for second eye surgery compared to community optometrists (RR = 1.434, 95% CI: 1.302-1.580, p < 0.0001). CONCLUSIONS: Optometrists provided an excellent postoperative care service with superior postoperative feedback rates compared to hospital doctors. EPRs facilitate a postoperative shared-care pathway that is of high quality and efficiency with major economic advantages.

Telemedicine for a General Screening of Retinal Disease Using Nonmydriatic Fundus Cameras in Optometry Centers: Three-Year Results.

PURPOSE: Describe the first 3 years of highly specialized retinal screening through a web platform using a retinologists' network for image reading. METHODS: All patients who came to centers in the network and consented to fundus photography were included. Images were evaluated by ophthalmologists. We describe number of patients, age, visual acuity, retinal abnormalities, medical recommendations, and factors associated with abnormal retinographies. RESULTS: Fifty thousand three hundred eighty-four patients were included; mean age 52.3 years (range 3-99). Mean visual acuity 20/25. Of the total cohort, 75% had normal retinographies, 22% had abnormalities, 1% referred acute floaters, 1% referred acute symptoms with normal retinography, and 1% could not be assessed. Ophthalmological referral was recommended in 12,634 patients: 9% urgent visit, 11% preferential (2-3 weeks), and 80% an ordinary visit. Age-related maculopathy signs were the most common abnormalities (2,456 patients, 4.8%). Epiretinal membrane was the second (764 cases, 1.5%). Diabetic retinopathy was suspected in 543 patients (1%), and nevi in 358 patients (0.7%). Patients older than 50 years had significantly more retinal abnormalities (31.5%) than younger ones (11.1%) (p < 0.0001; odds ratio [OR] 2.47; confidence interval [CI] 2.37-2.57). Patients with almost one eye with a myopic defect greater than -5 spherical equivalent had a higher risk of presenting abnormalities (p < 0.001; OR 1.04; CI 1.03-1.05). CONCLUSIONS: A high rate of asymptomatic retinal abnormalities was detected in this general screening, justifying this practice. Many patients who visit optometrists in Spain are unaware that they would benefit from ophthalmological monitoring. The ophthalmic community should lead initiatives of the type presented to preserve and guarantee quality standards.

Methods to Develop the Eye-tem Bank to Measure Ophthalmic Quality of Life.

PURPOSE: There is an increasing demand for high-standard, comprehensive, and reliable patient-reported outcome (PRO) instruments in all the disciplines of health care including in ophthalmology and optometry. Over the past two decades, a plethora of PRO instruments have been developed to assess the impact of eye diseases and their treatments. Despite this large number of instruments, significant shortcomings exist for the measurement of ophthalmic quality of life (QoL). Most PRO instruments are short-form instruments designed for clinical use, but this limits their content coverage often poorly targeting any study population other than that which they were developed for. Also, existing instruments are static paper and pencil based and unable to be updated easily leading to outdated and irrelevant item content. Scores obtained from different PRO instruments may not be directly comparable. These shortcomings can be addressed using item banking implemented with computer-adaptive testing (CAT). Therefore, we designed a multicenter project (The Eye-tem Bank project) to develop and validate such PROs to enable comprehensive measurement of ophthalmic QoL in eye diseases. METHODS: Development of the Eye-tem Bank follows four phases: Phase I, Content Development; Phase II, Pilot Testing and Item Calibration; Phase III, Validation; and Phase IV, Evaluation. CONCLUSIONS/DISCUSSION: This project will deliver technologically advanced comprehensive QoL PROs in the form of item banking implemented via a CAT system in eye diseases. Here, we present a detailed methodological framework of this project.

Eye care services utilisation among pregnant women in Nigeria.

One hundred and sixty-five pregnant Nigerian women attending the antenatal clinic of LAUTECH teaching hospital, Ogbomoso, Nigeria between January and April 2014 were interviewed using a structured questionnaire. Socio-demographic characteristics of the respondents were obtained. Respondents were also asked: if they had had their eye examined by an eye specialist during the index pregnancy, frequencies of visit to eye care centers and indications for their visitation. A history of previous eye examination by eye care specialist/visit to eye clinic was considered as eye care utilisation. Selection of eligible subjects who consented to participate in the study was done using simple random technique. Logistic regression model was used to control sociodemographic and obstetric factors in order to determine independent covariate factor influencing the use of eye care services. Among the population studied, only 46 (32%) had eye examination during the index pregnancy. Level of education and occupational status of the respondents were found to be statistically significant factors (p = 0.001 and 0.008, respectively). There is a need for a policy that will encourage regular eye care services usage during pregnancy.

Scope of practice of optometrists working in the UK Hospital Eye Service: a national survey.

PURPOSE: The role of the optometrist in the Hospital Eye Service (HES) has undergone significant development in recent years to include extended areas of clinical practice more traditionally undertaken by ophthalmologists, commensurate with a growing demand for increased capacity in ophthalmic services. In this report, we present the findings from a national survey of the scope of practice of optometrists working in the UK HES. METHODS: A survey was designed to incorporate questions on the provision of core services before seeking detailed information on the scope of practice within extended roles to include: ophthalmic sub-specialist areas where optometrists currently practice; the undertaking of specific procedures within these services; the relative autonomy of practice within these extended roles; and the training and accreditation requirements for working within extended roles. SurveyMonkey was used to disseminate the survey to the head of optometry in 79 HES units throughout the UK. RESULTS: Responses were received from 70 of the 79 (89%) survey invitations. A substantial majority of respondents (N = 67/70, 96%) indicated that optometrists undertook extended roles. Glaucoma is the leading extended role service provided by optometrists (92% of respondents providing extended role services), with roles in macula (71%), medical retina/diabetes (67%), cataract (55%) and corneal services (55%) also being relatively common. A wide variety of clinical procedures or interventions are undertaken as part of these services, which for a small number of optometrists now also includes the undertaking of specific laser procedures. There is evidence for a significant degree of autonomy within these extended roles. The primary mode of training is an 'apprentice' model, incorporating sessions worked under supervision in ophthalmology clinics. Methods of accreditation for optometric participation in extended role services are varied. CONCLUSIONS: While optometrists working within the UK HES continue to undertake the traditional clinical roles of refraction, clinically necessary contact lenses, and low vision rehabilitation, it is clear that these professionals now undertake a wide range of extended clinical roles, with a transformed scope of practice now incorporating diverse roles traditionally undertaken by medical practitioners.