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.

Prescribing patterns for hyperopia: an insight of the optometrist perspective and practice.

BACKGROUND: To investigate the current prescribing patterns for correcting hyperopia among optometrists in clinical practice in Saudi Arabia and compare those to current international guidelines. And explore the factors that influence practitioners' prescribing decision. METHOD: This cross-sectional study employed 30 items online survey that encompass demographic data, current practice and cycloplegia use, numerical response to indicate the minimum level of hyperopia at which optometrists would consider prescribing spectacles to non-strabismic children and determine the diopter value required for prescribing correction for hyperopia if present with other factors. RESULT: A total of 104 optometrists responded to the survey (52 females and 52 males). They recruited from 35 cities across Saudi Arabia. Out of total, 44% of them considered cycloplegic refraction essential under 12 years and 56% of them extended the range to 18 years. Large variation were found between the optometrists' responses and current guideline recommendations. Several factors influenced the decision-making of the practicing optometrist including signs and symptoms, bilateral hyperopia, average dioptric value, reading difficulty, and accommodative function. CONCLUSION: There are some matches between the international guidelines and the practice patterns that followed by optometrists in Saudi Arabia, however, the optometrists did not report that they are following them purposefully. These findings highlight the need to improve optometrists' practice about spectacle prescription in pediatric population.

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.

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.

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

SIGNIFICANCE: 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. PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

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.

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.

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.

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.

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

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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.

A review study on forensic optometry: new insights in forensic science to solve crime scenes, domestic violence and sexual assaults.

Forensic science has made a lot of progress in the medical field, but still ocular signs are not so well known to forensic scientists, whereas ocular signs play a very important role in forensic science. The major goal of this study to describe the importance of eye related clues in forensic science to solve the crime scenes and know the actual cause of death for the conviction of the criminals and save an innocent persons. Narrative review was done to review the articles available on the PubMed, Google Scholar, Research Gate, Web of Science and Medline related to the forensic optometry about the various methods of identification and strategies to deal with the forensic cases. The review covered studies that focused on interventions for forensic optometry and eye-related clues to the current study target. Twenty-seven of the 54 studies that met the inclusion criteria yielded good results, and all examined the significance of eye-related clues in forensic optometry. Peer reviewed articles/studies were referred to ascertain the eye related clues in the forensic science. Some authors suggest that eye related clues are very important aspects towards the forensic science and done the clinical research on that aspects. Criminal cases, domestic abuse and sexual assault affect people of all socioeconomic backgrounds. As a result, these traits would be highly valuable in determining the way of death and the chronological history of events leading up to a crime.

Perception of optometrists on causes of professional discordance among eye care professionals and its impact on refractive error service delivery in Kenya.

PURPOSE: To evaluate the perception of optometrists on causes of professional discordance among eye care professionals and its impact on refractive error service delivery in Kenya. METHODS: This was a prospective qualitative case study conducted between January and June 2022 among optometrists registered with the Optometrists Association of Kenya. The data was collected through telephonic interviews. Purposive sampling was used to recruit the participants. Descriptive statistics were presented using frequency, percentages and with p values. Thematic analysis was carried out for qualitative data using the NVivo Software, Version 11. It was an iterative process consisting of both deductive and inductive processes. RESULTS: Out of the 100 respondents, 37 (37%) were female. The mean age for the participants was 30.5 years with majority being in the age group 30-34 years. There was no statistically significant difference between the ages of males and females (p = 0.132) Most participants 82 (82%) had practiced for more than 4 years. The participants reported; mistrust among eye care professionals, employment sector, specialty, undermining the potential of other cadres within the eye care ecosystem, confusion and misconception and negative attitude as the perception of optometrists on causes of professional discordance among eye care professionals on refractive error service delivery. All of the optometrists agreed that professional discordance exists among eye care professionals in Kenya which potentially impacts negatively on refractive error service delivery. CONCLUSION: Professional discordance remains an underrated barrier which negatively impacts on refractive error service delivery. However, to achieve effective refractive error coverage, a strengthened team approach among eye care professionals is desirable in a country with limited human resource such as Kenya.

Comparison of the influence of alcohol and cannabis on the dynamics of the accommodative response.

PURPOSE: To assess and compare the changes produced by the two most commonly used substances, alcohol and cannabis, on accommodation dynamics. METHODS: A total of 38 young participants (19 females) were enrolled in the study. They were assigned to two groups: a cannabis group (N = 19) and an alcohol group. Participants in the cannabis group underwent two randomized sessions: a baseline session and a session after smoking a cigarette. Participants in the alcohol group underwent three randomized sessions: a baseline session, a session after the intake of 300 ml of red wine (Alcohol 1), and other after the ingestion of 450 ml of wine (Alcohol 2). For the accommodation assessment, the open-field autorefractor WAM-5500 was used. RESULTS: The decrease of the mean velocity of the accommodative response produced by Alcohol 2 condition was significantly greater than that observed for Alcohol 1 and Cannabis (p = 0.046). The direction of the accommodation (near-distance and distance-near) had no effect on the deterioration of the accommodation dynamics following substance use. The target distance had a significant effect on the decrease of the mean velocity following substance use (p = 0.002). The decrease of the amplitude of the accommodative response was associated with a decrease of the peak velocity (p = 0.004) and the increase of the accommodative lag (p < 0.001). CONCLUSIONS: A moderate-high dose of alcohol impairs accommodation dynamics to a greater extent that lower dose of alcohol or smoked cannabis. The deterioration of the accommodation mean speed was higher for a shorter target distance.

Improving eye care quality through brief verbal intervention on optometry service provider by using unannounced standardized patient with refractive error: study protocol for a randomized controlled trial.

BACKGROUND: Improper refractive correction can be harmful to eye health, aggravating the burden of vision impairment. During most optometry clinical consultations, practitioner-patient interactions play a key role. Maybe it is feasible for patients themselves to do something to get high-quality optometry. But the present empirical research on the quality improvement of eye care needs to be strengthened. The study aims to test the effect of the brief verbal intervention (BVI) through patients on the quality of optometry service. METHODS: This study will take unannounced standardized patient (USP) with refractive error as the core research tool, both in measurement and intervention. The USP case and the checklist will be developed through a standard protocol and assessed for validity and reliability before its full use. USP will be trained to provide standardized responses during optical visits and receive baseline refraction by the skilled study optometrist who will be recruited within each site. A multi-arm parallel-group randomized trial will be used, with one common control and three intervention groups. The study will be performed in four cities, Guangzhou and three cities in Inner Mongolia, China. A total of 480 optometry service providers (OSPs) will be stratified and randomly selected and divided into four groups. The common control group will receive USP usual visits (without intervention), and three intervention groups will separately receive USP visits with three kinds of BVI on the patient side. A detailed outcome evaluation will include the optometry accuracy, optometry process, patient satisfaction, cost information and service time. Descriptive analysis will be performed for the survey results, and the difference in outcomes between interventions and control providers will be compared and statistically tested using generalized linear models (GLMs). DISCUSSION: This research will help policymakers understand the current situation and influencing factors of refractive error care quality, and then implement precise policies; at the same time, explore short and easy interventions for patients to improve the quality of optometry service. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2200062819. Registered on August 19, 2022.

Analysis of 2-year spherical equivalent progression in emmetropic children with non-cycloplegic refraction: a retrospective chart review.

BACKGROUND: We aimed to investigate children with an emmetropic non-cycloplegic refraction (NCR) to compare the difference in progression of NC spherical equivalent (SE) over 2 years between the children with emmetropic and hyperopic cycloplegic refraction (CR) values. METHODS: Through a retrospective medical record review, 59 children aged under 10 years were evaluated. Refractive error was calculated as the average of the SE values of both eyes. According to the CR results, children with emmetropia (-0.50 to 1.00 diopter [D]) were assigned to group 1 (n = 29), and those with hyperopia (≥ 1.00 D) were assigned to group 2 (n = 30). The prevalence of myopia and SE progression were compared over 2 years. Correlations between final SE progression and baseline age and refractive error were analyzed and multiple regression analysis was conducted. Receiver operating characteristic curves that achieved the best cutoff points to distinguish between the groups were calculated. RESULTS: Group 1 showed significantly myopic SE changes compared to baseline at the 1-year follow-up, and group 1 was significantly myopic compared with group 2 at the 2-year follow-up. Myopia prevalence was 51.7% in group 1 and 6.7% in group 2 after 1 year, and 61.1% and 16.7% after 2 years, respectively. In the correlation analysis, baseline age, baseline CR, and difference between CR and NCR showed significant correlations with the 2-year SE progression (r = -0.359, p = 0.005; r = 0.450, p < 0.001; r = -0.562, p < 0.001, respectively). However, NCR refractive error showed no significant correlation (r = -0.097, p = 0.468). In multiple regression analysis, baseline age (ß= -0.082), and CR-NCR difference (ß= -0.214) showed a significant effect on SE progression for 2 years. When an NCR value of 0.20 D was set as the cut-off value to distinguish between the groups, a sensitivity of 70% and specificity of 92% were obtained. CONCLUSION: Even if NCR showed emmetropia, children with baseline CR values of emmetropia showed greater SE progression compared with those with hyperopia. Cycloplegia is essential to confirm the correct refractive status in children. It may be useful for predicting prognosis of SE progression.

Profiling and factors associated with glaucoma diagnostic practice in sub-Saharan Africa-a cross sectional study of Nigerian and Ghanaian optometrists.

BACKGROUND: Ghana and Nigeria are the two countries in Africa that currently run the Doctor of Optometry (OD) program in sub-Saharan Africa (SSA). Optometrists in these countries are licensed to provide glaucoma care. Despite the clinically relevant practice guidelines for glaucoma, there is no data on the practice patterns for glaucoma eye care in SSA, a region with the highest prevalence of glaucoma. This study aimed to profile glaucoma diagnosis adherence to practice guidelines among optometrists in two neighbouring anglophone countries (Nigeria and Ghana). METHODS: A web-based cross-sectional survey of practising optometrists was conducted in both countries. Each country data was weighted to reflect the total number of licensed and practising optometrists at the time of this survey. Descriptive analyses were performed against demography and practice factors using survey commands to adjust for sampling weights when estimating confidence intervals (CI) around prevalence estimates. Simple and multiple logistic regression analyses were performed to identify factors associated with glaucoma diagnosis. RESULTS: A total of 493 optometrists (238, 48.3% and 255, 51.7%) from Ghana and Nigeria respectively, responded to the survey-the first to document and compare the glaucoma diagnostic criteria between optometrists in Ghana and Nigeria. More Ghanaian than Nigerian optometrists diagnosed glaucoma and over 90% in both countries reported that they frequently performed either tonometry, visual field testing, or fundus examination during glaucoma diagnosis. Ghanaian optometrists were significantly more likely to diagnose glaucoma than Nigerian optometrists (adjusted odd ratio, AOR = 6.15, 95%CI:1.63-23.15, P = .007). Optometrists who have practiced for more than 10 years (AOR = 7.04; 95%CI:1.74-28.47, P = .006) and private practice optometrists (AOR = 3.33; 95%CI:1.13-9.83, P = .03) were more likely to diagnose glaucoma. CONCLUSIONS: The study provides information for evaluating glaucoma assessment for optometrists in both countries. Optometrists in both countries are reasonably well-equipped to diagnose glaucoma and are practicing at an adequate level, but with room for improvement.

Comparison of the new self-contained darkroom refractive screener versus table-top autorefractor and cycloplegia retinoscopy in detecting refractive error.

PURPOSE: By comparing the results of the new self-contained darkroom refractive screener (YD-SX-A) versus table-top autorefractor and cycloplegic retinoscopy, to evaluate the performance of the YD-SX-A in detecting refractive error in children and adolescents and then judge whether it can be used in refractive screening. METHODS: Cross-sectional study. 1000 participants between the ages of 6 and 18 who visited the Optometry Center of the People's Hospital of Guangxi Zhuang Autonomous Region from June to December 2022 were selected. First, participants were instructed to measure their diopter with a table-top autorefractor (Topcon KR8800) and YD-SX-A in a noncycloplegic setting. After cycloplegia, they were retinoscopy by a professional optometrist. The results measured by three methods were collected respectively. To avoid deviation, only the right eye (1000 eyes) data were used in the statistical analysis. The Bland-Altman plots were used to evaluate the agreement of diopters measured by the three methods. The receiver operating characteristic (ROC) curves was used to analysis effectiveness of detecting refractive error of YD-SX-A. RESULTS: The average age of participants was 10.77 ± 3.00 years, including 504 boys (50.4%) and 496 girls (49.6%). When YD-SX-A and cycloplegia retinoscopy (CR) were compared in the myopia group, there was no statistical difference in spherical equivalent (SE) (P > 0.05), but there was a statistical difference in diopter spherical (DS) and diopter cylinder (DC) (P < 0.05). Comparing the diopter results of Topcon KR8800 and CR, the difference between each test value in the myopia group was statistically significant (P < 0.05). In the hyperopia group, the comparison between YD-SX-A and CR showed no statistically significant differences in the DC (P > 0.05), but there were significant differences in the SE and DS (P < 0.05). In the astigmatism group, the SE, DS, and DC were statistically different, and the DC of YD-SX-A was lower than that of CR and Topcon KR8800. Bland-Altman plots indicated that YD-SX-A has a moderate agreement with CR and Topcon KR8800. The sensitivity and specificity of YD-SX-A for detecting myopia, hyperopia and astigmatism were 90.17% and 90.32%, 97.78% and 87.88%, 84.08% and 74.26%, respectively. CONCLUSION: This study has identified that YD-SX-A has shown good performance in both agreement and effectiveness in detecting refractive error when compared with Topcon KR8800 and CR. YD-SX-A could be a useful tool for large-scale population refractive screening.

Survey of the Faculty Status of Optometrists at Academic Medical Centers in the United States.

SIGNIFICANCE: This is the first study of the prevalence and faculty status of optometrists practicing at academic medical centers in the United States. PURPOSE: This study aimed to quantify the number of optometrists at academic medical centers, along with faculty rank and post-doctoral training programs. METHODS: The official Web sites of academic medical centers and schools of medicine in the United States were examined during the 2021 to 2022 academic year to identify departments of ophthalmology and collect faculty profiles of employed optometrists. Institutional data were cross-referenced and analyzed by geographic distribution. Data were gathered from the Association of Schools and Colleges of Optometry and Accreditation Council on Optometry Education to identify post-graduate training programs in optometry. RESULTS: A total of 192 academic medical centers were identified, of which 121 (63.02%) had a residency or fellowship program in ophthalmology and/or optometry. One hundred twenty-five (65.10%) of these institutions had at least one staff optometrist. Seven hundred eighteen optometrists were found at these institutions, representing 1.83% of the 39,205 practicing optometrists estimated in the United States. Of the 718 optometrists, 369 (51.39%) held an academic appointment at a medical school. The most common academic rank was assistant professor (184 [25.63%]), followed by instructor (138 [19.22%]), associate professor (34 [4.74%]), and full professor (13 [1.81%]). The distribution of academic rank was similar across all regions but varied between institutions as to whether all, some, or none of the optometric faculty were appointed by a medical school. Of 296 optometry residency programs in the United States, 21 (7.09%) were at an academic medical center. Of 15 optometric fellowship programs in the United States, 3 (20%) were at an academic medical center. Of the 192 institutions in this study, 22 (11.46%) had a post-doctoral optometric training program. CONCLUSIONS: This study shows the distribution of academic rank and post-doctoral training programs for optometrists at academic medical centers.

Financial Inequities in Optometric Education in Canada: A Comparison of Two Optometry Programs.

SIGNIFICANCE: The advancing age of the population will require increased access to eye care services to manage eye diseases and vision correction. Optometric education requires a sound financial plan to manage student debt. This study evaluates the financial inequalities of optometric programs in Canada and how this may impact the provision of eye care professionals. PURPOSE: The objective of this study was to compare the financial inequities in optometric education in Canada from the 2020 graduating class. METHODS: A cross-sectional study assessed monetary variables related to the study of optometry in Canada, including academic and personal expenses, and overall debt and expenses related to the COVID-19 lockdown for the 2020 graduating class. RESULTS: A total of 108 optometry students from the 2020 graduating classes of the University of Montreal and the University of Waterloo responded, with 68 (female/male respondents, 53:15; mean [standard deviation] age, 25.66 [2.01] years) completing the study. Waterloo students spent more years in university ( P < .001), had higher academic fees ( P < .001), spent more on traveling to their family residence ( P = .007), and received more provincial ( P = .002) and federal ( P < .001) loans than Montreal students. Overall debt before optometry was similar among students but differed ( P < .001) at the end of their program, with Waterloo students having a higher debt burden. CONCLUSIONS: There is a financial inequity in optometric education in Canada depending on the chosen program. Cumulative optometry student debt for the 2020 graduating class in Canada ranges from Can $0 to $189,000 with an average of Can $65,800 and a median of Can $50,000. The results of this study can assist financial and government agencies, and future optometry students to better understand the financial burdens and establish a financial plan to study optometry in Canada, to respond to the growing eye care needs of the public.