Conducting Health Literacy Research With Hard-to-Reach Regional Culturally and Linguistically Diverse Populations: Evaluation Study of Recruitment and Retention Methods Before and During COVID-19.

BACKGROUND: In health research, culturally and linguistically diverse (CALD) health care consumers are cited as hidden or hard to reach. This paper evaluates the approach used by researchers to attract and retain hard-to-reach CALD research participants for a study investigating health communication barriers between CALD health care users and health care professionals in regional Australia. As the study was taking place during the COVID-19 pandemic, subsequent restrictions emerged. Thus, recruitment and retention methods were adapted. This evaluation considered the effectiveness of recruitment and retention used throughout the pre-COVID and during-COVID periods. OBJECTIVE: This evaluation sought to determine the effectiveness of recruitment and retention efforts of researchers during a study that targeted regional hard-to-reach CALD participants. METHODS: Recruitment and retention methods were categorized into the following 5 phases: recruitment, preintervention data collection, intervention, postintervention data collection, and interviews. To compare the methods used by researchers, recruitment and retention rates were divided into pre-COVID and during-COVID periods. Thereafter, in-depth reflections of the methods employed within this study were made. RESULTS: This paper provides results relating to participant recruitment and retainment over the course of 5 research phases that occurred before and during COVID. During the pre-COVID recruitment phase, 22 participants were recruited. Of these participants, 15 (68%) transitioned to the next phase and completed the initial data collection phase. By contrast, 18 participants completed the during-COVID recruitment phase, with 13 (72%) continuing to the next phase. The success rate of the intervention phase in the pre-COVID period was 93% (14/15), compared with 84.6% (11/13) in the during-COVID period. Lastly, 93% (13/14) of participants completed the postintervention data collection in the pre-COVID period, compared with 91% (10/11) in the during-COVID period. In total, 40 participants took part in the initial data collection phase, with 23 (58%) completing the 5 research phases. Owing to the small sample size, it was not determined if there was any statistical significance between the groups (pre- and during-COVID periods). CONCLUSIONS: The success of this program in recruiting and maintaining regional hard-to-reach CALD populations was preserved over the pre- and during-COVID periods. The pandemic required researchers to adjust study methods, thereby inadvertently contributing to the recruitment and retention success of the project. The maintenance of participants during this period was due to flexibility offered by researchers through adaptive methods, such as the use of cultural gatekeepers, increased visibility of CALD researchers, and use of digital platforms. The major findings of this evaluation are 2-fold. First, increased diversity in the research sample required a high level of flexibility from researchers, meaning that such projects may be more resource intensive. Second, community organizations presented a valuable opportunity to connect with potential hard-to-reach research participants.

Idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN): new observations and a proposed staging system.

PURPOSE: To review the clinical features, disease progression, and effects of treatment on idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN). DESIGN: Retrospective interventional case series. PARTICIPANTS: Ten patients with IRVAN originally reported in 1995 and 12 additional patients identified since the original series. INTERVENTION: Patients in the series had testing that may have included fluorescein angiography, indocyanine green angiography, and systemic evaluation. Treatments included panretinal laser photocoagulation, cryotherapy, vitrectomy surgery, and injection of periocular or intravitreal steroids. MAIN OUTCOME MEASURES: Initial visual acuity (VA), initial stage at diagnosis, clinical course, surgical intervention, final VA, and complications of disease. RESULTS: A total of 44 eyes of 22 patients were studied; 9 eyes had reached stage 1 or 2 disease at last follow-up, 17 had reached stage 3, and 12 had reached stage 4 or 5. At the time of last follow-up, 14 eyes had maintained 20/20 vision, 15 had between 20/40 and 20/200 vision, and 9 had 20/300 vision or worse. Later stages of retinal ischemia are associated with worse VA. Thirty-two of 38 followed eyes were treated. Twenty-five were treated initially with panretinal laser photocoagulation. The clinical course of each eye after initiation of panretinal laser photocoagulation was evaluated with respect to the final VA and stage of ischemic retinopathy at the initiation of treatment. Panretinal laser photocoagulation was initiated in 3 eyes at stage 2, 16 at stage 3, 5 at stage 4, and 1 at stage 5. Seven eyes underwent grid laser retinal photocoagulation of the macula for macular edema. CONCLUSIONS: Idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis is an isolated retinal vascular disease that can progress rapidly to severe vision loss due to ischemic sequelae despite treatment with panretinal laser photocoagulation. Based on our review of the largest cohort of IRVAN patients, early panretinal laser photocoagulation should be considered when angiographic evidence of widespread retinal nonperfusion is present, and before (or shortly after) the development of neovascularization. A functional staging system is proposed to improve treatment paradigms.

A comparison of digital retinal image quality among photographers with different levels of training using a non-mydriatic fundus camera.

PURPOSE: To evaluate the quality of digital retinal images taken by three photographers with different levels of photographic training, using a non-mydriatic fundus camera. METHODS: This study compares 45-degree digital retinal images taken with a non-mydriatic fundus camera by three different photographers with different levels of photographic training: (I) A professional ophthalmic photographer with 20 years of experience; (2) a non-professional photographer with 2 days of photographic training and experience with 50 patients; (3) a non-professional photographer with 1 hour of photographic training and experience with 10 patients. The quality of the photographs was evaluated by the consensus of two retina specialists. RESULTS: Sixty-four (64) eyes of 33 subjects were imaged by the three photographers for a total of 192 images. Thirty-four eyes were photographed in the non-dilated state. The trained ophthalmic photographer and the two non-professional photographers did not have statistically significant differences in image quality based on the image evaluations. (Chi-square P-value: 0.57). This finding was consistent for eyes in both the non-dilated and dilated state. CONCLUSIONS: Fundus image quality for images taken with a non-mydriatic camera were not significantly different among three photographers with different levels of training.

The current status of diabetes care, diabetic retinopathy screening and eye-care in British Columbia's First Nations Communities.

OBJECTIVES: The objective of this study was to evaluate the current status of primary diabetes care, diabetic retinopathy screening, and eye-care for First Nations individuals with diabetes living on-reserve in British Columbia. STUDY DESIGN: Prospective cross-sectional observational survey. METHODS: A mail-out survey was sent to all BC First Nations Communities in the format of a 26-item questionnaire. A series of general questions were asked concerning community populations, regional transportation options and the availability of local health-care providers. Specific questions about the frequency and source of eye and diabetic retinopathy care in each community were also solicited. RESULTS: A sixty-seven percent questionnaire response rate was achieved (136/202 communities). The community-reported rate of diabetes mellitus ranged from 4.8 to 11.8% with an average of 6.4%. The proportion of on-reserve individuals with diabetes receiving yearly retinal examinations for diabetic retinopathy was found to be only 33%. Many communities received eye-care from more than one professional group, but the majority of basic eye-care and retinopathy screening was provided by optometrists. Ophthalmologists were less likely to provide eye care for these communities; however, family physicians and nurses were frequently responsible for performing eye evaluations. CONCLUSIONS: The vast majority of First Nations people with diabetes who live on-reserve in British Columbia do not have access to annual examinations by an eye-care professional. Eye evaluations and retinal screening were often the responsibility of individuals with little formal training in this area.

Technique for removal of a capsular tension ring from the vitreous.

PURPOSE: To report a new technique for safely and quickly removing a displaced capsular tension ring from the vitreous cavity. DESIGN: Two interventional case reports. PARTICIPANTS: The authors retrospectively reviewed the charts of two patients with displaced capsular tension rings (CTRs). INTERVENTION: Surgical removal of the displaced CTRs was performed in two patients. MAIN OUTCOME MEASURES: Visual and anatomic outcomes. RESULTS: The CTRs were removed surgically, in case 1 by cutting the CTR into two pieces before removal and in case 2 by using the CTR injector to remove the CTR in one piece through a sclerotomy site. Both patients had good visual and anatomic outcomes. CONCLUSIONS: The described technique of removing a displaced CTR in one piece through a sclerotomy site using the CTR injector provides a safe and efficient method of CTR removal. Cutting the CTR into two or more pieces for removal is not recommended.

Assessment of vision-related function in patients with age-related macular degeneration.

OBJECTIVE: To investigate the validity of the visual function index (VF-14) in assessing visual function in patients with age-related macular degeneration (AMD). DESIGN: Prospective noncomparative observational case series. PARTICIPANTS: One hundred fifty-nine consecutive patients attending a sole practitioner's academic retina-only clinic from May 1998 through August 1998 and from May 1999 through August 1999. MAIN OUTCOME MEASURES: Correlations were calculated between the VF-14 scores and the medical outcomes study 36-item short form (SF-36), weighted comorbidity scale, visual acuity and clinical AMD severity (stage), and vision self-assessment scales. Documentation of the severity of macular degeneration was performed by a sole examiner. RESULTS: There was a moderately strong correlation between visual acuity and trouble with vision (r = 0.51), satisfaction with vision (r = -0.50), and overall quality of vision (r = -0.56). A strong correlation was noted between VF-14 score and patients' self-rating of amount of trouble with vision (r = -0.67), satisfaction with vision (r = 0.62), and overall quality of vision (r = 0.67). In comparison, correlations between SF-36 score and patients' self-rating of amount of trouble with vision, satisfaction with vision, and overall quality of vision ranged from r = 0.37 to r = -0.40. Linear regression analysis for the overall study population indicated that AMD severity was not an independently significant predictor of VF-14 score after adjusting for visual acuity. However, among patients with 20/20 vision in the better eye, AMD severity was an independently significant predictor of VF-14 score after adjusting for visual acuity in the worse eye. CONCLUSIONS: The VF-14 exhibits a considerable degree of validity as a measure of functional impairment in patients with AMD. Age-related macular degeneration severity was an independently significant predictor of VF-14 score in the group of patients with 20/20 vision in the better eye, but this did not hold true for the overall study population. Age-related macular degeneration is associated with substantial impairment in reported visual function.

Inverted pneumatic retinopexy: a method of treating retinal detachments associated with inferior retinal breaks.

PURPOSE: To introduce the new approach of inverted pneumatic retinopexy for the management of rhegmatogenous retinal detachments with inferior retinal breaks. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Eleven patients presenting with rhegmatogenous retinal detachments with causative inferior retinal breaks. INTERVENTION: Sterile gas/air injection, cryopexy/laser retinopexy, with inverted positioning. MAIN OUTCOME MEASURES: Postoperative primary and final anatomical outcome, visual acuity, and complications. RESULTS: Patients were followed for a minimum of 3 months (mean, 5.1 months). Primary retinal reattachment was obtained in 10 of 11(91%) patients. One patient sustained a redetachment secondary to proliferative vitreoretinopathy, resulting in a single operation reattachment rate of 82%. Final reattachment was obtained in 11 of 11 (100%) patients. Mean visual acuity improved about 3 lines from 20/60 to 20/30, with 11 of 11 patients experiencing improvement in their visual acuity. Two patients required an additional surgical procedure to achieve final anatomic success. No new breaks were identified in the postoperative period, and no complications resulted from the pneumatical procedure. CONCLUSIONS: Inverted pneumatic retinopexy can successfully repair retinal detachments with inferior retinal breaks under appropriate conditions.